Special Supplemental Benefits for the Chronically Ill (SSBCI)

SSBCI benefits can be offered to Medicare Advantage members with one or more complex chronic conditions, who are at high risk for hospitalization or adverse health outcomes, and who require intensive care coordination. These benefits are in addition to the benefits that traditional Medicare covers, and can include non-primarily health related benefits so long as there is a reasonable expectation of improving or maintaining the health or overall function of the member.

To be eligible for Special Supplemental Benefits for the Chronically Ill (SSBCI) benefits, members must have one or more of the following conditions:

  1. Chronic alcohol use disorder and other substance use disorders
    • Alcohol use disorder
    • Opioid use disorder
    • Cannabis use disorder
    • Sedative, hypnotic, or anxiolytic use disorder
    • Cocaine use disorder
    • Other stimulant use disorder
    • Nicotine dependence
    • Inhalant use disorder
    • Other psychoactive substance use disorder
  2. Autoimmune disorders:
    • Psoriatic arthritis
    • Rheumatoid arthritis
    • Systemic lupus erythematosus
    • Dermatomyositis
    • Polymyositis
    • Polyarteritis nodosa
    • Polymyalgia rheumatica
    • Scleroderma
  3. Cancer (excluding pre-cancer conditions or in-situ status)
  4. Cardiovascular disorders:
    • Cardiac arrhythmias
    • Coronary artery disease
    • Chronic venous thromboembolic disorder
    • Peripheral vascular disease
  5. Chronic heart failure
  6. Dementia
  7. Diabetes mellitus
    • Type 1 diabetes mellitus
    • Type 2 diabetes mellitus
  8. Chronic gastrointestinal disease
    • Hepatitis B
    • Hepatitis C
    • Pancreatitis
    • Inflammatory bowel disease
    • Non-alcoholic fatty liver disease (NAFLD)
  9. Chronic kidney disease (CKD)
    • CKD requiring dialysis/End-stage renal disease (ESRD)
  10. Severe hematologic disorders:
    • Aplastic anemia
    • Hemophilia
    • Immune thrombocytopenic purpura
    • Myelodysplastic syndrome
    • Sickle-cell disease (excluding sickle-cell trait)
    • Chronic venous thromboembolic disorder
  11. HIV/AIDS
  12. Chronic lung disorders:
    • Asthma
    • Chronic bronchitis
    • Emphysema
    • Chronic Obstructive Pulmonary Disease (COPD)
  13. Chronic and disabling mental health conditions:
    • Bipolar disorders
    • Major depressive disorders
    • Paranoid disorder
    • Schizophrenia
    • Schizoaffective disorder
  14. Neurologic disorders:
    • Fibromyalgia
    • Chronic fatigue syndrome
    • Spinal cord injury
    • Amyotrophic lateral sclerosis (ALS),
    • Epilepsy
    • Cerebral Palsy,
    • Extensive paralysis (that is, hemiplegia, quadriplegia, paraplegia, monoplegia)
    • Huntington’s disease
    • Multiple sclerosis
    • Parkinson’s disease
    • Polyneuropathy
    • Spinal stenosis
    • Stroke-related neurologic deficit
  15. Stroke
  16. Post-organ transplantation care.
  17. Immunodeficiency and Immunosuppressive disorders.
  18. Conditions associated with cognitive impairment:
    • Alzheimer’s disease
    • Dementia