What is SSBCI

Congress allowed these benefits in the Bipartisan Budget Act of 2018. Plans could start offering them in 2020. They are optional. A plan may offer them, a different set, or none. Unlike a doctor visit, which the plan must cover for every member, an SSBCI item is only for members the plan decides meet its chronic-illness rules. If the plan includes the benefit, you do not buy it as a separate policy. Limits, vendors, and prior approval can still apply. The federal definition is in 42 CFR 422102.

A diagnosis is not an approval

The federal test has three parts, and the person has to meet all three. The condition is life threatening or seriously limits health or function. There is a high risk of hospitalization or another bad outcome. The person needs intensive care coordination. The benefit itself has to have a reasonable chance of improving or maintaining health or function. Heart failure, COPD, diabetes, and kidney disease are examples people ask about. A diagnosis on that list is not enough. The plan’s written rules, and the plan’s review of claims or a doctor’s note, are what count. Income or trouble paying rent, by itself, is not the test.

The categories a plan can file

CMS uses ten categories for these extras. A plan may file one, several, or none. It may also name up to five other items that are not on the list. Aetna’s Los Angeles County filing names personal care items as one of those. Filing a category is not the same as handing every member the item.

  • Food and produce. Groceries, not a meal delivered after a hospital stay.
  • Meals beyond a limited basis. This is separate from a short run of post-discharge meals that a plan may offer more widely.
  • Pest control.
  • Transportation for non-medical needs. A ride to the grocery store or another non-medical stop. A ride to the doctor is a different benefit. Read transportation benefits.
  • Indoor air quality equipment and services.
  • A social needs benefit. Help with a non-medical need that affects health. Trouble paying rent, by itself, is not the test.
  • Complementary therapies.
  • Services that support directing your own care.
  • Structural home modifications. Changes to the home, such as a grab bar, when the plan includes them.
  • General supports for living. The file splits this into utilities, housing, or both. Rent and a mortgage are not a standard Medicare benefit. They appear only when that plan’s rules include them.

How a plan decides

You have to be in the plan first. There is no separate policy to buy. The plan then decides, and two neighbors in the same plan can get different answers.

The plan uses records. Claims, a doctor’s note, a health-risk assessment, or a care-management review can be part of that. Telling the plan you want the card is not the review. Aetna’s page says you cannot qualify by asking. Wellcare’s page says a diagnosis is not enough. It looks at hospital or emergency visits, frequent outpatient care, poor control of the illness, or a social need that affects health. A social need can be one factor. It cannot be the only one.

Wellcare also says the review is for that plan year and ends December 31. A new year, or a new company, can mean a new review. Joining a Chronic Condition Special Needs Plan is a separate step. Anthem says the form for these extras is not the form that lets you join that type of plan. Read Special Needs Plans.

How to read a dollar amount

The dollar figures later on this page come from the CMS file. Most of them are a combined package, not a grocery-only allowance. A $110 card that also covers over-the-counter items is one pile of money. Toothpaste and groceries come out of the same amount.

A blank dollar field means the file did not state a maximum. It does not mean the benefit is unlimited. The file says unlimited only when it marks that box. Wellcare’s meals category is one of those marks, and the same plan also lists meals on a shared $113 card, so the Evidence of Coverage has to settle which rule applies.

Many monthly and quarterly amounts expire at the end of that period. The file does not say whether unused money rolls over. The Evidence of Coverage does. It also names the stores, the foods, the vendor, and whether you have to ask or the plan contacts you.

For 2027, a plan that offers these items has to post the written rules, and a debit card used for them has to connect the purchase to items the plan covers. That change is with the other 2027 Medicare changes. County food help is a different program. The Los Angeles County food list is not a plan card.

Where the companies post their rules

These are public pages companies had posted as of October 15, 2026. A page can describe a benefit the plan in your ZIP does not include. Medicare.gov and the Evidence of Coverage are the check.

Aetna’s SSBCI eligibility page uses the three-part federal test. It says you cannot qualify by asking. Aetna names four items, and each one has an extra rule: an Extra Supports Wallet for food, utilities, or transportation, which on some plans also requires Extra Help; a High Value Provider Incentive for members who use a participating primary care doctor, also with Extra Help on some plans; a Healthy Heart Partnership for congestive heart failure, which you choose to join; and Companion Care, which a care manager identifies from health records.

UnitedHealthcare’s public article says the items vary by plan. The examples it names are a healthy-food allowance, help with utility bills, non-medical transportation, help with rent or a mortgage, in-home safety equipment, and pest control. It says the plan verifies eligibility. UnitedHealthcare says the full qualification list is on its member site. That site asks you to sign in, so it is not linked here.

SCAN’s 2026 benefits note says the FlexEssentials card may include groceries, and that groceries are not based on a diagnosis alone. The conditions it names are cardiovascular disorders, chronic heart failure, diabetes, cancer, and chronic lung disorders. It says other conditions may apply and that SCAN uses medical records. SCAN’s SSBCI questionnaire lists more conditions and tells you to read the Evidence of Coverage.

Blue Shield of California has posted an attestation for a Food and Produce benefit on its Medicare + Medi-Cal plan (HMO D-SNP). The form says not all members qualify. It lists chronic conditions and does not state a dollar amount. It is not a catalog of every Blue Shield plan.

Anthem’s California Special Needs page says you may be reviewed for SSBCI if you have a high risk of hospitalization and need intensive care coordination for a condition such as chronic kidney disease, a chronic lung disorder, a cardiovascular disorder, chronic heart failure, or diabetes. It says the full list is in Chapter 4 of that plan’s Evidence of Coverage. A January 2026 provider notice names utilities and Healthy Foods as examples, and says that review is separate from joining a Chronic Condition Special Needs Plan.

Wellcare’s California 2027 eligibility page posts the three-part test and says a diagnosis is not enough. It looks at hospital or emergency visits, frequent outpatient care, poor control of the illness, or a social need that affects health. The note on that page names cancer, cardiovascular disorders, chronic and disabling mental health conditions, chronic lung disorders, and diabetes, and says other conditions exist. The page does not name the items, such as food or utilities. The Evidence of Coverage does.

Humana’s SSBCI page describes food, utilities, transportation, and in-home support. None of Humana’s eight Los Angeles County plans in the 2027 file filed an SSBCI category.

Los Angeles County in 2027

The CMS benefit file for 2027, posted October 1, 2026, has 124 Medicare Advantage plans in Los Angeles County. ZIP 91006 is in that county. Seventy-four filed at least one SSBCI category. Fifty did not. A dollar figure is the maximum the plan filed for that package. When the package also includes over-the-counter items, dental, vision, hearing, or fitness, the SSBCI item shares that amount. It is not an approval. Medicare.gov is the full plan list. This page does not rank plans.

SCAN, including the DaVita dialysis plan filed under VillageHealth. SCAN’s other six plans in this county file did not include an SSBCI category. Where a ride benefit is listed and no dollar amount is shown, the file does not state a trip limit. Those rides are filed as one-way trips by taxi, rideshare, or van:

  • SCAN Connections (HMO D-SNP): $110 a month for food and utilities, shared with over-the-counter items. Pest control and indoor air quality share a $1,300 yearly package with home-safety items. Non-medical rides have no dollar maximum in the file.
  • SCAN Connections at Home (HMO D-SNP): $145 a month for food and utilities, shared with over-the-counter items. Pest control and indoor air quality share a $2,000 yearly package with home-safety items. Non-medical rides have no dollar maximum in the file.
  • SCAN Strive (HMO C-SNP): $140 a month for groceries and utilities, shared with over-the-counter items. Non-medical rides have no dollar maximum in the file.
  • SCAN Balance (HMO C-SNP): $50 a month for groceries, shared with over-the-counter items, plus non-medical rides with no dollar maximum in the file.
  • SCAN Allied (HMO): $65 a month for groceries, shared with over-the-counter items.
  • SCAN Costco Medicare Advantage (HMO): $115 every 3 months for groceries, shared with over-the-counter items, plus non-medical rides with no dollar maximum in the file.
  • SCAN Ansim Care (HMO C-SNP): $750 every 3 months for food, shared with over-the-counter items, fitness, dental, vision, and hearing, plus non-medical rides.
  • SCAN Baekse (HMO): $375 every 3 months for groceries, shared with over-the-counter items, fitness, dental, vision, and hearing.
  • SCAN Embrace Together (HMO I-SNP): a $30 monthly plan maximum for food and produce, plus non-medical rides with no dollar maximum in the file.
  • SCAN Embrace (HMO I-SNP): non-medical rides, with no dollar maximum in the file.
  • SCAN Inclusive (HMO): non-medical rides, with no dollar maximum in the file, and $200 a year for support for directing your own care.
  • SCAN DaVita Dialysis Care Complete (HMO-POS C-SNP): food and produce and utilities. This file does not state a dollar maximum.

Aetna, Anthem, Blue Shield, UnitedHealthcare, and Wellcare

Each line is a Los Angeles County plan that filed an SSBCI category. The other plans from that company in this county file did not.

  • Anthem Full Dual Advantage Aligned (HMO D-SNP): $110 a month for food and utilities, shared with over-the-counter items and home-safety items.
  • Anthem I CareMore Kidney Care (HMO-POS C-SNP): $100 a month for food and utilities, shared with over-the-counter items and home-safety items.
  • Anthem I CareMore Chronic Care 2 and Lung Care 2 (HMO-POS C-SNP): $75 a month for food and utilities, shared with over-the-counter items and home-safety items.
  • Anthem I CareMore Chronic Care and Lung Care (HMO-POS C-SNP): utilities, with a $150 plan maximum every 3 months. A separate package caps general supports at $500 a year and shares that package with dental, vision, hearing, home-safety items, and health-related rides.
  • Aetna Medicare Chronic Care (HMO C-SNP): $25 a month for food and general supports, shared with over-the-counter items. The file also lists non-medical transportation, described as the cost of gasoline, and personal care items.
  • Blue Shield Medicare + Medi-Cal Plan (HMO D-SNP): $240 every 3 months for food and produce, shared with over-the-counter items.
  • UHC Complete Care CA-18P (HMO-POS C-SNP): $40 a month for food and produce, shared with over-the-counter items and home-safety items.
  • UHC Complete Care Support CA-1AP (HMO C-SNP): $113 a month for food and produce, shared with over-the-counter items and home-safety items.
  • Wellcare Health Net Dual Align (HMO D-SNP): $113 a month shared by food, meals, pest control, non-medical rides, social needs, utilities, housing, and over-the-counter items. The meals category is also marked unlimited. The Evidence of Coverage has to be read before treating both as available.

The other Los Angeles County companies

These companies also have Medicare Advantage plans in the same county file. Humana’s eight plans filed no SSBCI category. Alignment Health Plan filed a category on all 21 of its plans. Where a monthly amount is shown, it is food and utilities shared with over-the-counter items:

  • Central Health Harmony Plus 002 (HMO C-SNP): $240 a month. Heart & Diabetes Plus 044 (HMO C-SNP): $171 a month. Heart & Diabetes Plus 039 (HMO C-SNP): $127 a month.
  • Clarity Plus 042 (HMO C-SNP): $103 a month. Balance 033 (HMO C-SNP): $100 a month. BRIDGE 003 (HMO): $100 a month for food, shared with over-the-counter items.
  • BreathEasy Plus 041 (HMO C-SNP): $99 a month. Honor Plus 060 (HMO): $97 a month. Central Health Harmony 001 (HMO): $95 a month.
  • No dollar amount in the file: Heart & Diabetes 054 and 010 (food, pest control, indoor air, and utilities). Platinum + Instacart 008 and Heart & Diabetes 051 (food, pest control, and supports). My Choice 050 (food, pest control, and utilities). My Choice 001 (pest control, indoor air, and utilities). Advantage 001 (PPO): pest control and supports. Advantage 005 (PPO), Smart 055, Smart 047, Smart 013, and ValorCare 053: pest control only.
  • Astiva Health C-SNP Deluxe: $250 a month for food, shared with over-the-counter items. Fountain, WOW, and Bloom: $265 a month on the same kind of card. Astiva Health Savings Plan filed no SSBCI category.
  • Clever Care Breathe+ and Total+: $610 every 3 months for food, shared with over-the-counter items, fitness, dental, vision, and hearing. Longevity: $330 every 3 months. Total Choice+ and Breathe Select+: $310 every 3 months. Value: $95 every 3 months. All six share the card the same way.
  • Elite Signature: $450 every 3 months for food, shared with over-the-counter items, fitness, and hearing. Elite Core: $75 every 3 months, shared the same way.
  • Champion Ally: $225 every 3 months for food and utilities, shared with over-the-counter items. Choice, Plus, Advantage, Connect, and Care filed food and utilities with no dollar amount. Secure filed a social-needs category with no dollar amount. Compass and Home filed no SSBCI category.
  • Imperial Flex: $300 every 3 months for food, utilities or housing, and pest control, shared with over-the-counter items, fitness, and health-related rides. Senior Value and Dynamic Plan filed food with no dollar amount. Courage Plan filed no SSBCI category.
  • Kaiser Permanente Dual Complete South P9: $160 every 3 months for food, shared with over-the-counter items. The other two Kaiser plans in this county file did not include an SSBCI category.
  • L.A. Care Medicare Plus: $120 a month for food, utilities or housing, and non-medical rides, shared with over-the-counter items.
  • Molina Medicare Complete Care Plus: $133 a month for food, utilities or housing, and non-medical rides, shared with over-the-counter items and hearing.
  • Align Senior Care Premier Care: $185 every 3 months. Senior Care: $290 every 3 months. Advantage Care: $175 every 3 months. Each card covers utilities or housing and is shared with over-the-counter items and hearing. All three also filed non-medical rides with no dollar maximum.
  • AHF PHP (HMO C-SNP): food, pest control, indoor air, and supports, with no dollar amount in the file.
  • UCLA Health Medicare Advantage Prestige: food, meals, and home modifications, with no dollar amount in the file. The Principal plan filed no SSBCI category.

How this differs from other coverage

Original Medicare does not include these extras. A Supplement letter does not add them. Extra Help lowers some Part D costs. Medi-Cal is California’s Medicaid program. Neither one is SSBCI. A few Aetna items also require Extra Help. That is Aetna’s extra rule, not the federal test.

Dental, vision, hearing, and a gym benefit, when a plan offers them, are usually offered to members who meet the plan’s general rules. SSBCI is narrower. A grocery card in a commercial can also be an over-the-counter allowance with a food piece that only some members can use. Read which piece is which before you treat the whole card as groceries.

Switching plans in the fall can drop an extra you are using if the next plan does not include it, or if the next plan does not approve you. Read the Annual Notice of Change.

What to ask

Ask the plan, not an advertisement: Do you offer SSBCI? Which conditions do you review? What is actually included, and what is the limit? Do you contact members, or do I have to ask? What does my doctor need to send? Which vendor provides the service? The public pages above are a start. They are not a substitute for the Evidence of Coverage for your ZIP code. Medicare.gov is the full plan list. This website does not rank plans. The other 2027 Medicare changes include the rule that these criteria be public.