Context
Since 2017, the Value-based Insurance Design (VBID) model has enabled Medicare Advantage plans to offer non-medical benefits such as allowances for specific items like healthy food, utilities, and transportation based solely on Extra Help or Low-Income Subsidy (LIS) eligibility. The VBID model is ending at the end of 2025. As a result, the requirements to access these benefits benefits has changed.
In 2026, these benefits will be offered as Special Supplemental Benefits for the Chronically Ill (SSBCIs) for beneficiaries with specific qualifying chronic conditions. Carriers will continue to administer these benefits through pre-funded debit cards; however, members will need to complete a carrier-specific chronic condition verification process to access them. Carriers will communicate chronic condition verification requirements to both members on both new and existing plans that offer SSBCIs (typically DSNPs) as part of the plan onboarding experience. Members are required to complete their verification within the first 60 days of their coverage or they will lost access to SBBCIs..
Members who lose or are denied access to SSBCIs are at risk of submitting carrier complaints or complaints to Medicare. Outside of completing HRAs at the time of enrollment, agents cannot complete the chronic verification process for their clients. Agents can proactively educate their clients on the importance of condition verification and connect with their members to ensure that this process is complete. This is critical to protecting member benefits and preventing CTMs and rapid disenrollments due to plan dissatisfaction.
AEP 2026
Spark recommends all agents execute outreach to their DSNP members, particularly those who have not completed HRAs, to educate, support, and confirm that they have completed their verification process.
D-SNP Beneficiaries
D-SNP beneficiaries are the most likely to be affected by chronic condition verification requirements for SSBCIs because many D-SNP plans offer SSBCIs as a core part of the member value proposition. While D-SNP eligibility is tied to Medicaid status, SSBCI eligibility is separate and requires confirmation of a qualifying chronic condition, even when the member already receives Medicaid cost-sharing support or other enhanced benefits. If a D-SNP member’s qualifying condition is not verified or documented, they may retain their D-SNP coverage but will lose access to specific SSBCI benefits.
C-SNP Beneficiaries
C-SNP members will also qualify for SSBCIs offered with their coverage. C-SNP plans require Primary Care Providers to complete a chronic verification form for these members to retain their coverage. This process will also qualify those members for SSBCIs. If C-SNP members do not have verification of a chronic condition from their PCP, they will lose their coverage, along with any provided access to SSBCIs, within the first 60 days of their plan. Learn more about the C-SNP verification process here.
Non-SNP Beneficiaries
There are cases where non-SNP policies have offered or will offer similar non-medical benefits in the past. While less common, members on these plans will also need to complete the required verification steps.
Qualifying Conditions
Qualifying Conditions
Chronic alcohol use disorder and other substance use disorders (SUDs)
Autoimmune disorders:
• Polyarteritis nodosa
• Polymyalgia rheumatica
• Polymyositis
• Dermatomyositis
• Rheumatoid arthritis
• Systemic lupus erythematosus
• Psoriatic arthritis
• Psoriasis
• Scleroderma
Cancer
Cardiovascular disorders:
• Cardiac arrhythmias
• Coronary artery disease
• Peripheral vascular disease
• Valvular heart disease
Chronic heart failure
Dementia
Diabetes mellitus
Overweight, obesity, and metabolic syndrome
Chronic gastrointestinal disease:
• Chronic liver disease
• Non-alcoholic fatty liver disease (NAFLD)
• Hepatitis B
• Hepatitis C
• Pancreatitis
• Irritable bowel syndrome
• Inflammatory bowel disease
Chronic kidney disease:
• CKD requiring dialysis/End-
stage renal disease (ESRD)
• CKD not requiring dialysis
Severe hematologic disorders:
• Aplastic anemia
• Hemophilia
• Immune thrombocytopenic purpura
• Myelodysplastic syndrome
• Sickle cell disease (excluding
sickle cell trait)
• Chronic venous
thromboembolic disorder
HIV/AIDS
Chronic lung disorders:
• Asthma, chronic bronchitis
• Cystic fibrosis
• Emphysema
• Pulmonary fibrosis
• Pulmonary hypertension
• Chronic Obstructive Pulmonary
Disease (COPD)
Chronic disabling mental health conditions:
• Bipolar disorders
• Major depressive disorders
• Paranoid disorder
• Schizophrenia
• Schizoaffective disorder
• Post-traumatic stress disorder (PTSD)
• Eating disorders
• Anxiety disorders
Neurologic disorders:
• Amyotrophic lateral sclerosis (ALS)
• Epilepsy
• Extensive paralysis (that is, hemiplegia, quadriplegia, paraplegia, monoplegia)
• Huntington’s disease
• Multiple sclerosis
• Parkinson’s disease
• Polyneuropathy
• Fibromyalgia
• Chronic fatigue syndrome
• Spinal cord injuries (added in 20.)
• Spinal stenosis
• Stroke-related neurologic deficit
Stroke
Post-organ transplantation care
Immunodeficiency and immunosuppressive disorders
Conditions associated with cognitive impairment:
• Alzheimer’s disease
• Intellectual disabilities and developmental disabilities
• Traumatic brain injuries
• Disabling mental illness associated with cognitive impairment
• Mild cognitive impairment
Conditions with functional challenges and require similar services, including the following:
• Spinal cord injuries
• Paralysis
• Limb loss
• Stroke
• Arthritis
Chronic conditions that impair vision, hearing (deafness), taste, touch, and smell
Conditions that require continued therapy services in order for individual to maintain or retain functioning
Hypertension
Hyperlipidemia
Anemia
Chronic Pain
Agent Best Practices
Identify the chronic condition requirements when reviewing special/flex benefits during enrollment.
SSBCIs wil appear under Special or Flex Benefits within a plan's Summary of Benefits.
“You may get these benefits if you have a qualifying chronic condition or other factors. Contact the plan to see if you qualify before you enroll” appears at the top of this section.
Complete HRAs.
For some carriers, a completed Health Risk Assessment covers the chronic condition verification process. Be sure to complete all HRAs for your SNP.
Reach out to your DSNP clients in January.
While SSBCIs are not limited to DSNP plans, it is safe to assume that the vaset majority of your DSNP clients have received or expect to receive non-medical support. Prioritize reaching out to your DSNP clients to confirm the status of their SSBCI access in January.
Questions to ask:
Have they receive received a non-medical debit card from their carrier?
Confirm if they have any qualifying chronic conditions.
Have they received any instructions from their carrier on qualifying their chronic condition?
Identify your members with chronic conditions in Spark.
The Spark platform can store your clients chronic conditions to make it easier to identify your members that qualify for SSBCIs.
Add your client’s chronic conditions to your contacts in Spark using the instructions here.
Pull a list of your contacts with chronic conditions in Spark using the instructions here.
Track verification in carrier portals.
UHC currently provides SSBCI verification statuses in Jarvis for all DSNP members. Follow the instructions here to review which of your members have not completed their verification.
Carrier Verification Processes
Carriers will execute outreach to SSBCI eligible members as part of plan onboarding. Leading carriers strive to capture 90% of eligible verification in this process. Agents can use the following resources to support their clients in completing their verification.
Members are required to complete the following processes within the first 60 days of coverage. If they do not they will lose access to any existing SSBCIs they are receiving.
Carrier | Plan Eligibility | Verification Process | More Resources |
UHC | Qualifying D-SNP Plans | - Members self-indicate their chronic condition on their enrollment application and they will receive access to SSBCIs at beginning of coverage.
- Members can also self-indicate during the first 60 days of coverage using the UHC member mobile app.
- UHC will verify member attestations with their provider within the first 60 days of coverage. |
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Humana | Dual Eligible Special Needs (D-SNP) members: at least one verified chronic condition.
Non-Special Needs (Non-SNP) or General Enrollment (GE) members: at least two verified chronic conditions. | - Attestation completed via HRA at the time of enrollment.
- Members can use self-service options to complete the HRA after enrollment: digitally on MyHumana.com or by calling the number on the back of their spending account card.
- Members can wait for claims to be processed to determine eligibility (no member action required). If one qualified chronic condition claim is processed. |
- HRA FAQ |
Devoted | - Food and Home card is offered on over half of Devoted plans. Confirm in plan summary of benefits if a plan qualifies. | - Completion of an HRA, indicating they have Cardiovascular Disease, Obesity (BMI over 40), or Diabetes.
- Member Attestation (via Guide call or Member Portal) acknowledging one of the ~60 eligible conditions
- Devoted is currently reviewing the available evidence (Claims/MMR data) to determine member qualifications and will communicate these statuses in early November.
- For Non-CSNP members who still lack qualifying evidence (Claim/MMR/Provider Confirmation) in January, Devoted will assist them in scheduling D2Me appointments for Provider Confirmation
- Ensure members are set up to receive text notifications from Devoted, as this is the best way to stay updated on information related to the Food & Home card | |
Aetna | - New members can self-attest 10 days after enrolling by: - Calling Aetna Member Services (number on their member ID card) - Completing an online form through the Aetna Health member portal (available after January 1, 2026)
- For D-SNP members only, Aetna will use Rx claims data in addition to medical claims.
- For Value plans, eligibility for the Extra Supports Wallet requires both an eligible chronic condition and confirmation of Extra Help status. Extra Help eligibility is verified using data provided by CMS daily. CMS evaluates a beneficiary’s eligibility for Extra Help annually. |
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Elevance |
| - Brokers need to provide the Chronic Condition Verification Form to the member during enrollment if their plan includes the Everyday Options Allowance. If we show that the member still needs to qualify, we will mail a Chronic Condition Verification Form to them in the mail. The member will need to have their healthcare provider complete and return the form to us. They will be able to buy approved grocery products, and pay for eligible utility bills, with their allowance if their Everyday Options Allowance includes these benefits. Members will have a180-day temporary funding period to access SSBCI benefits while completing and eturning the Chronic Condition Verification Form with their provider. |
- Anthem Member Onboarding Packet (details under “Everyday Options Allowance” section.) |
Wellcare |
| - Members may be automatically (current and new members) or manually (new members only) qualified.
- Automatic: Wellcare’s internal systems have enough data to verifythat a member already meets the required criteria. For dual-eligible members, both Medicare and Medicaid claims are cross-referenced to determine eligibility. Once a member is qualified, they automatically receive the benefit, and a detailed benefit letter is mailed out to them.
- Manual: New members may follow our manual qualification process to qualify for SSBCI benefits. In 2026, that process requires members on eligible plans to work with their provider of choice to have an attestation submitted that shows the member meets all eligibility criteria.
New members who do not auto-qualify for SSBCI may contact Member Services for information on the manual attestation process. Members will receive a letter with step-by-step instructions explaining the process for a provider to attest to the member’s eligibility. If a member wishes to go through the manual attestation process, they must do so within the first four months of enrollment. |
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