Patients who buy health insurance on the federal marketplace will be able to select a plan that includes BJC HealthCare locations in its network, thanks to a last-minute deal with insurer Aetna, health system officials confirmed Wednesday.
The announcement comes as another health insurer, Cigna, stopped offering marketplace plans in Missouri for 2024. Cigna’s announcement worried some patients, who were concerned that the health insurer’s exit left patients without a marketplace plan that offered BJC providers in its network.
A spokeswoman said the health system is informing current Cigna marketplace patients of the change. Blue Cross Blue Shield offers marketplace health plans for BJC patients in Illinois.
Open enrollment on the federal health insurance exchange starts today and runs through Dec. 15 for coverage that begins Jan. 1. The marketplace is where people who are self-employed or who otherwise prefer to shop for their own insurance plans can buy health coverage.
Insurers and health systems regularly negotiate the rates insurers will pay for procedures. Insurers agree to offer certain hospitals within a health network and hospitals agree to give insurers a discounted rate.
The relatively small number of health systems and insurers vying to cover the St. Louis region could have contributed to Cigna’s departure, said Abigail Barker, a health economics professor at Washington University.
“So if you have three or four health systems in a metropolitan area, and you also have sort of a similar handful of insurers, it's got all the potential for inefficiency on both sides,” she said. “I mean, that’s just such a small number.”
Barker said BJC — a nationally-ranked academic medical chain — could be pulling for higher prices. That can later be reflected in a health insurer’s premium prices, which could mean fewer people will be tempted to buy that insurer’s policy on the marketplace.
“If one plan tries to compensate for that and have that coverage, they're going to end up having their premium be a little bit higher,” Barker said. “So maybe it reflects a $20 higher premium showing up on the healthcare.gov website… Well, that's almost like the kiss of death.”
Insurers can negotiate and bring down prices by threatening to exclude hospitals from their network, said Krutika Amin who is a health policy expert at the KFF, an independent health policy research organization.
“If insurers want to drive down costs, they have to appear willing to walk away,” she said. “And what that can mean for consumers is their providers that they like going into might not be in-network for their plan.”
Elsewhere, options for marketplace customers in the St. Louis region are plentiful, said Ryan Barker, the vice president of policy and advocacy at the St. Louis Integrated Health Network.
“While it is always a loss to consumer choice when an insurer leaves the market, there in the St. Louis region — St. Louis City, St. Louis County, and St. Charles — there are still seven different insurance choices in the marketplace,” he said.
Barker said that all marketplace patients, not just former Cigna marketplace customers, should check healthcare.gov to review plans, since providers and premiums change year-to-year.
