Do You Qualify? Special Medicare Advantage Benefits for People with Chronic Conditions
If you have a chronic illness and Medicare Advantage, you might be eligible for benefits you've never heard about—including help with groceries, rides to the store, and even home repairs.
Beyond Basic Medicare Coverage
Medicare Advantage Plans can offer additional benefits that Original Medicare doesn’t cover, like routine vision and dental care, hearing aids, and gym memberships. But some people may not be aware that Medicare Advantage Plans can also provide extra benefits for people with certain long-term chronic conditions. These additional benefits are called Special Supplemental Benefits for the Chronically Ill (SSBCI).
What SSBCI Benefits Can Include
According to CMS, the purpose of SSBCI benefits is to better tailor offerings, address gaps in care, and improve health outcomes for the chronically ill population. SSBCI benefits can include things that are not primarily health-related, but can help with everyday needs that affect your health, such as:
- Groceries and fresh produce
- Prepared meals beyond a limited or temporary basis
- Home Modifications (e.g., grab bars or ramps)
- Indoor air quality equipment and/or services (e.g., air purifiers)
- Rides to places other than medical appointments
- Pest Control
- Social Needs Benefits
- Complementary Therapies
- Services Supporting Self Direction
Who Qualifies for SSBCI Benefits?
There is no specific list of chronic conditions that automatically qualify someone for SSBCI. However, CMS defines a chronically ill enrollee as an individual who:
- Has one or more comorbid and medically complex chronic conditions that are life-threatening or significantly limit overall health or function
- Has a high risk of hospitalization or other adverse health outcomes
- Requires intensive care coordination
Ultimately, your Medicare Advantage Plan will determine if you meet the criteria to be eligible for SSBCI benefits. Keep in mind that SSBCI benefits are not guaranteed, and eligibility will only be determined after enrollment in the plan.
To find out what additional benefits or SSBCI options your plan offers, review your Evidence of Coverage (EOC), available on your plan’s website or by request. You can also contact your plan directly to ask which benefits you may qualify for.
Flex Cards and Public Benefits
Many SSBCI benefits are offered through a pre-loaded debit card, called a “Flex Card.” Since Flex Cards are becoming more popular, many people may wonder how Flex Cards affect other public benefits. Guidance from federal agencies provides clarity:
- Medicaid and SNAP (Supplemental Nutrition Assistance Program): Flex Cards are not counted as income or resources when determining eligibility.
- Housing Assistance (HUD): Flex Cards are only counted as income if used to pay for rent or utilities. All other Flex Card expenditures are excluded from annual income calculations.
The U.S. Department of Housing and Urban Development (HUD) has also issued FAQs with examples showing how these exclusions should be applied, as well as guidance for housing providers on verifying Medicare Advantage supplemental benefits.
