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

Alcohol use disorder
Cannabis use disorder
Cocaine use disorder
Inhalant use disorder
Nicotine dependence
Opioid use disorder
Other psychoactive substance use disorder
Other stimulant use disorder
Sedative, hypnotic, or anxiolytic use disorder

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. Chronic 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

11. Conditions Associated with Cognitive Impairment

Alzheimer’s disease

12. Dementia

13. Diabetes Mellitus

Type 1 diabetes mellitus
Type 2 diabetes mellitus

14. HIV / AIDS

15. Immunodeficiency and Immunosuppressive Disorders

16. Post-Organ Transplantation Care

17. Severe Hematologic Disorders

Aplastic anemia
Chronic venous thromboembolic disorder
Hemophilia
Immune thrombocytopenic purpura
Myelodysplastic syndrome
Sickle-cell disease (excluding sickle-cell trait)

18. Stroke

This page was last updated on October 24, 2025.