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:

Autoimmune disorders

• Polyarteritis nodosa
• Psoriatic Arthritis
• Polymyalgia rheumatica
• Dermatomyositis
• Scleroderma
• Polymyositis
• Rheumatoid arthritis
• Systemic lupus erythematosus

Cancer

(excluding pre-cancer conditions or in-situ status)

Cardiovascular disorders

• Cardiac arrhythmias
• Chronic heart failure
• Coronary artery disease
• Peripheral vascular disease
• Chronic venous thromboembolic disorder

Chronic alcohol or drug dependency

Chronic and disabling mental health conditions

• Bipolar disorders
• Major depressive disorders
• Paranoid disorder
• Schizophrenia
• Schizoaffective disorder

Chronic gastrointestinal disease

• Pancreatitis
• Inflammatory bowel disease

Non-alcoholic fatty liver disease

Hepatitis B or C

Chronic kidney disease

• Must be on dialysis

Chronic lung disorders

• Asthma
• Chronic bronchitis
• Emphysema
• Chronic Obstructive Pulmonary Disease (COPD)

Neurologic disorders

• Amyotrophic lateral sclerosis (ALS)
• Fibromyalgia
• Chronic Fatigue Syndrome
• Spinal Cord Injury
• Epilepsy
• Cerebral Palsy
• Extensive paralysis (i.e., hemiplegia, quadriplegia, paraplegia, monoplegia)
• Huntington’s disease
• Multiple sclerosis
• Parkinson’s disease
• Polyneuropathy
• Spinal stenosis
• Stroke or related neurologic deficit

Severe hematologic disorders

• Aplastic anemia
• Hemophilia
• Immune thrombocytopenic purpura
• Myelodysplastic syndrome
• Sickle-cell disease (excluding sickle-cell trait)

This page was last updated on February 26, 2026.