Enhanced Medicare Benefits for Long-Term Illnesses (Supplemental Benefits for Chronically Ill)
The Medicare Advantage (Part C) plans offer additional benefits to Original Medicare beneficiaries, including Special Supplemental Benefits for the Chronically Ill (SSBCI). These benefits are designed to support individuals living with chronic illnesses who require extra assistance.
To be eligible for SSBCI benefits, a person must have a high chance of needing hospitalization or facing other serious health challenges. They must also live with a chronic illness, defined as having serious and complex health conditions that are life-threatening or significantly impact their overall health or ability to function.
Each Part C plan determines the amount of money it will put into a debit card for approved expenses if it offers one and how often it will reload it. These preloaded debit cards can be used for approved expenses such as nutritious groceries, non-medical rides, and utilities. However, SSBCI benefits generally do not include coverage for cosmetic procedures, funeral costs, life insurance policies, alcohol, tobacco, cannabis, or certain foods.
The 2018 Bipartisan Budget Act enhanced Part C plans to include SSBCI benefits. These benefits can include tailored supplemental benefits such as expanded dental, vision, hearing coverage, chronic condition support, home environment modifications, non-emergency transportation, and telehealth services beyond standard Medicare coverage. Some plans may also cover non-medical services like support with meal preparation, therapy, pest control, air-quality equipment, social support, home modifications, and living-support items.
It's important to note that a person must still pay the Part B premium to stay enrolled in a Part C plan, but some plans may cover this cost. To enroll in a Part C plan, a person must do so during the appropriate enrollment period, such as the Initial Enrollment Period, Open Enrollment Period, General Enrollment Period, Medicare Advantage Open Enrollment, or a Special Enrollment Period for approved reasons.
The average monthly premium for Part C plans in 2025 is around $17.00, according to the Centers for Medicaid & Medicare (CMS). A person can explore available Part C plans, their benefits, and costs in their area on Medicare.gov.
It's also worth mentioning that SSBCIs are specific benefits offered by some Medicare Advantage (Part C) plans, while C-SNPs are specific Part C plans tailored for people with chronic illnesses. The list of qualifying conditions for a Chronic Condition Special Needs Plan (C-SNP) can help understand what health conditions Medicare might consider chronic for SSBCIs. However, it's important to note that there is no specific SSBCI chronic conditions list.
In conclusion, SSBCI benefits can provide valuable additional support for individuals living with chronic illnesses. It's essential to understand the eligibility criteria, the benefits offered, and the costs involved to make an informed decision about enrolling in a Part C plan. For more information, visit Medicare.gov.
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