Medicare Advantage (MA), also known as Part C, provides benefits that are similar to or better than Original Medicare. Offered by private insurance companies and replacing Part A (hospital insurance) and Part B (medical insurance), Medicare Advantage plans can include additional benefits like gym memberships, hearing aids and exams, and over-the-counter pharmacy allowances. 

One significant benefit MA plans offer over Original Medicare is SSBCI. These non-medical benefits specifically cater to people with complex chronic illnesses to help them manage their condition. If you’re curious about SSBCI benefits or are wondering about your eligibility, keep reading to learn how it can apply to you. 

What is SSBCI?

Special Supplemental Benefits for the Chronically Ill (SSBCI) are additional benefits offered by some Medicare Advantage plans to chronically ill enrollees, many of whom require care coordination and/or are at increased risk of hospitalization. 

Introduced in the Bipartisan Budget Act of 2018, SSBCI are supplemental, often non-medical benefits that help enrollees with complex, life-threatening, chronic illnesses maintain or improve their health conditions. Benefits included in SSBCI have a “reasonable expectation” of improving enrollees’ quality of life. This “reasonable expectation” is a standard defined by MA plan providers and affirmed by the Centers for Medicare and Medicaid Services (CMS). 

SSBCI Medicare benefits

Medicare Advantage plan providers can use their discretion to determine which benefits are included in SSBCI. Ultimately, the benefits take the form of:

• Reduced cost-sharing for Medicare-covered benefits
• Reduced cost-sharing for primarily health-related supplemental benefits
• Additional, primarily health-related supplemental benefits
• Non-primarily health-related benefits

Some non-medical benefits can include (but aren’t limited to):

• Home-delivered or prepared meals
• Produce, frozen foods, and canned goods
• Reimbursed, arranged, or directly provided transportation
• Pest control
• Indoor air quality equipment and services
• Access to community or plan-sponsored programs and events
• Services supporting self-direction
• Structural home modification
• General support for living

Though SSBCI includes a wide range of services, the following services are not included:

• Cosmetic procedures like facelifts and bone loss due to aging
• Hospital indemnity insurance
• Funeral planning expenses
• Life insurance
• Alcohol
• Tobacco
• Cannabis products
• Non-healthy food

SSBCI vs. C-SNPs

Both SSBCI and C-SNPs (Chronic Condition Special Needs Plans) share the goal of improving the health outcomes of people with chronic health conditions, but they aren’t exactly the same. Specifically, SSBCI is a category of benefits that can be included in MA plans based on pre-determined criteria, while C-SNP is a type of Medicare Advantage plan that caters to the non-medical social needs of Medicare and Medicaid-eligible people with chronic conditions. 

Simply put, C-SNP is a plan type, and SSBCI are benefits included in that plan. 

Do I qualify for SSBCI?

Many chronically ill enrollees are eligible for SSBCI. CMS defines a chronically ill person as someone who:

• Has one or more comorbid and medically complex chronic condition that is life-threatening or significantly limits the overall health or function of the enrollee
• Has a high risk of hospitalization or other adverse health outcomes
• Requires intensive care coordination

While Medicare Advantage plan providers have to follow CMS’s definition of a chronically ill enrollee, they can use their own processes for determining who qualifies. The chronic conditions that qualify for SSBCI can include:

• Chronic alcohol and other drug dependence
• Some autoimmune disorders, like rheumatoid arthritis and polymyositis
• Cancer (not including pre-cancer conditions or in situ status)
• Some cardiovascular disorders, like cardiac arrhythmias and coronary artery disease
• Chronic heart failure
• Stroke
• Dementia
• Diabetes mellitus
• End-stage liver disease
• End-stage renal disease (ESRD) that requires dialysis
• Some severe hematologic disorders, like hemophilia and sickle-cell disease
• HIV/AIDS
• Some chronic lung disorders, like asthma and emphysema
• Some chronic and disabling mental health conditions, like bipolar disorder and schizophrenia
• Some neurologic disorders, like epilepsy and Huntington’s disease

How can I enroll in a plan with SSBCI?

SSBCI isn’t guaranteed and is approved based on your determined eligibility. If you enroll in an SSBCI-eligible plan but don’t meet the criteria for chronic illness, you may not be able to take advantage of these benefits. Plus, SSBCI isn’t available in Original Medicare plans, so even if you have chronic conditions, you won’t be able to access these specific benefits. 
However, if you haven’t yet enrolled in a Medicare Advantage plan and think you may qualify, you can use Medicare’s plan finder to find a plan in your area. If you’re looking for more in-depth guidance to determine if you qualify and compare your options, SmartMatch can guide you through the process and help you find a plan that best suits your situation.