SSBCI qualifying chronic conditions
As the Value-Based Insurance Design (VBID) model ends Dec. 31, 2025, Medicare Advantage plans, including Dual Special Needs Plans (D-SNP), will experience changes. However, the Special Supplemental Benefits for the Chronically Ill (SSBCI) will remain a key program, continuing to support individuals with specific chronic health needs.
SSBCI allows Medicare Advantage plans to offer non-medical, health-related benefits like healthy foods and utility assistance, tailored to individuals with serious chronic illnesses. Note that unlike VBID, SSBCI does not include benefits related to prescription drugs or Part D.
Qualifying conditions*:
- Diabetes mellitus (type 1 or type 2)
- Cardiovascular disorders
- Chronic heart failure
- Chronic hypertension (chronic high blood pressure)
- Chronic hyperlipidemia (chronic high cholesterol)
- Autoimmune disorders
- Cancer
- Chronic alcohol use disorder and other substance use disorders (SUDs)
- Chronic gastrointestinal disease
- Chronic kidney disease (CKD)
- Chronic lung disorders
- Chronic and disabling mental health conditions
- Dementia
- HIV/AIDS
- Immunodeficiency and immunosuppressive disorders
- Myasthenia Gravis/Myoneural Disorders and
Guillain-Barre Syndrome/Inflammatory and
Toxic Neuropathy - Neurologic disorders
- Overweight, obesity and metabolic syndrome
- Post-organ transplantation care
- Severe hematologic disorders
- Stroke
- Conditions associated with cognitive impairment
- Conditions with functional challenges and require similar services including spinal cord injuries, paralysis, limb loss, stroke and arthritis
*To be eligible for SSBCI, members must meet several requirements that will be confirmed by the plan, including diagnosis of a qualifying chronic condition, plan eligibility, and additional clinical criteria such as being at high risk for hospitalization or adverse health outcomes and requiring intensive care coordination.
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