What SSBCI is
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.
A diagnosis is not an approval
Plans look for a chronic condition that is life threatening or that seriously limits health or function, a high risk of hospitalization or another bad outcome, and a need for intensive care coordination. Heart failure, COPD, diabetes, and kidney disease are examples people ask about. The plan’s list and the plan’s review are what count. Your doctor’s note may be required. Some plans look at claims and contact you. Others wait until you ask. Being told you have a condition, on this website or on a commercial, is not an enrollment in the benefit.
What plans sometimes include
The Evidence of Coverage is the list. Examples that come up, and are not a promise, include meals or groceries tied to the illness, rides beyond a standard transportation benefit, pest control, air-quality equipment, and some safety changes at home such as grab bars. A debit card, if the plan uses one, is supposed to pay only for the approved items. Housing, rent, and utility help are not a standard Medicare benefit. If a plan mentions them, read the dollar limit and the approval rule. The transportation article covers ordinary plan rides, which are separate. County food programs are listed under food resources.
How this differs from other plan extras
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. Two neighbors in the same plan can have different access. One may be offered meal delivery after a heart-failure review. The other may not. Standard medical benefits still apply to both. Switching plans in the fall can drop an extra you are using if the next plan does not include it. 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? CMS is also requiring plans that offer certain SSBCI items to make eligibility criteria easier to find. That change is described with the other 2027 Medicare changes. Medicare.gov is the full plan list. This website does not rank plans.
Common questions
- Does every Medicare Advantage plan offer SSBCI?
- No. SSBCI is optional. Many plans do not offer it. The Evidence of Coverage for that plan and ZIP code is the check.
- If I have diabetes or heart failure, do I qualify?
- Not automatically. The plan applies its own chronic-illness rules. This website cannot say that you qualify.
- Is SSBCI the same as Extra Help or Medi-Cal?
- No. Extra Help is a Social Security program for Part D costs. Medi-Cal is California’s Medicaid program. SSBCI is an optional Medicare Advantage extra for some members with serious chronic illness.
- Will a debit card from the plan pay rent or groceries?
- Only if that plan’s rules say so, and only for the items and amounts it approves. A card in a commercial is not a promise. Read the Evidence of Coverage.
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