2026 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. Autoimmune Disorders

  • Dermatomyositis

  • Polymyalgia rheumatica

  • Polyarteritis nodosa

  • Polymyositis

  • Psoriatic arthritis

  • Rheumatoid arthritis

  • Scleroderma

  • Systemic lupus erythematosus


2. Cancer

  • All cancer diagnoses (excluding pre-cancer conditions or in-situ status)


3. Cardiovascular Disorders

  • Cardiac arrhythmias

  • Chronic venous thromboembolic disorder

  • Coronary artery disease

  • Peripheral vascular disease


4. Chronic Alcohol or Drug dependency


5. Chronic and Disabling Mental Health Conditions

  • Bipolar disorder

  • Major depressive disorder

  • Paranoid disorder

  • Schizoaffective disorder

  • Schizophrenia


6. Chronic Gastrointestinal Diseases

  • Hepatitis B

  • Hepatitis C

  • Inflammatory bowel disease

  • Non-alcoholic fatty liver disease (NAFLD)

  • Pancreatitis


7. Chronic Heart Failure


8. Chronic Kidney Disease (CKD)

  • Must be on dialysis


9. Chronic Lung Disorders

  • Asthma

  • Chronic bronchitis

  • Chronic Obstructive Pulmonary Disease (COPD)

  • Emphysema

10. Conditions associated with cognitive impairment

  • Alzheimer’s disease

  • Dementia

11. Diabetes

12. Immunodeficiency and Immunosuppressive Disorders

  • HIV


13. Neurologic Disorders

  • Amyotrophic lateral sclerosis (ALS)

  • Cerebral palsy

  • Chronic fatigue syndrome

  • Epilepsy

  • Extensive paralysis (hemiplegia, monoplegia, paraplegia, quadriplegia)

  • Fibromyalgia

  • Huntington’s disease

  • Multiple sclerosis

  • Parkinson’s disease

  • Polyneuropathy

  • Spinal cord injury

  • Spinal stenosis

  • Stroke-related neurologic deficit


14. Post-Organ Transplantation Care


15. Severe Hematologic Disorders

  • Aplastic anemia

  • Chronic venous thromboembolic disorder

  • Hemophilia

  • Immune thrombocytopenic purpura

  • Myelodysplastic syndrome

  • Sickle-cell disease (excluding sickle-cell trait)


16. Stroke