Special Supplemental Benefits for the Chronically Ill (SSBCI) represent a significant shift in how Medicare Advantage (MA) plans support their members. Unlike traditional benefits that focus strictly on medical care, SSBCI allows plans to cover “non-primarily health-related” items that address social determinants of health.1
A Brief History of SSBCI
SSBCI was established by Congress through the CHRONIC Care Act, which was passed as part of the Bipartisan Budget Act of 2018.2
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Purpose: To give Medicare Advantage plans more flexibility to provide tailored services to the most vulnerable, high-cost members.
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Timeline: While traditional supplemental benefits (like vision and dental) have existed for years, SSBCI officially became available to MA plans starting in 2020.
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Evolution: Since its inception, the variety of benefits offered has grown exponentially, expanding from simple meal delivery to complex services like pest control and structural home modifications.3
How People Qualify
To receive SSBCI, a person must be enrolled in a Medicare Advantage plan that offers these benefits and meet a three-part statutory test defined by CMS:
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Qualifying Chronic Condition: The member must have one or more complex chronic conditions (e.g., Diabetes, Chronic Heart Failure, COPD, End-Stage Renal Disease, or Severe Hematologic Disorders) that is life-threatening or significantly limits their overall health or function.4
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High Risk: The member must be at high risk for hospitalization or other adverse health outcomes.5
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Care Coordination: The member must require “intensive care coordination” to manage their health effectively.6
How it’s verified: Plans often identify eligible members through claims data or “Health Risk Assessments.”7 Alternatively, a doctor may need to submit a Provider Attestation Form confirming the diagnosis and risk level.8
The Benefits Provided
The core philosophy of SSBCI is that an item or service is covered if it has a “reasonable expectation of improving or maintaining the health or overall function” of the chronically ill member.9
| Category | Common Examples |
| Food & Groceries | Allowances for healthy food, produce, and home-delivered meals (beyond a short-term post-hospitalization stay). |
| Utilities & Living | Subsidies for gas, electric, water, or even rent/mortgage assistance in some specific cases. |
| Home Environment | Pest control, indoor air quality equipment (HEPA filters, AC units), and carpet cleaning. |
| Structural Mods | Home modifications like wheelchair ramps, widening doorways, or installing grab bars. |
| Transportation | Rides for non-medical needs, such as grocery shopping or banking. |
| Social Support | Companion care, social club memberships, or services to reduce social isolation. |
Key Limitation
It is important to note that not all Medicare Advantage plans offer SSBCI, and those that do may offer different versions of the benefits. Unlike standard Medicare benefits, SSBCI does not have to be offered uniformly to every member in a plan; it is targeted specifically to those who meet the medical criteria.