Medicare SSBCI vs. VBID: What’s the Difference
Two major innovations in the Medicare Advantage (MA) program; special supplemental benefits for the chronically Ill (SSBCI) and the Value-Based Insurance Design (VBID) Model, both aim to improve outcomes for beneficiaries with chronic conditions. However, they differ in purpose, eligibility, benefits, and future outlook. Here’s what you should know about Medicare SSBCI vs VBID and how they compare.
What Is SSBCI
The Special Supplemental Benefits for the Chronically Ill (SSBCI) program was created under the Bipartisan Budget Act of 2018. It allows Medicare Advantage plans to offer non-traditional, non-medical benefits designed to help people with serious chronic illnesses maintain or improve their health and daily function.
To qualify, a beneficiary must:
- Have one or more complex chronic conditions,
- Be at high risk of hospitalization or other negative outcomes, and
- Require intensive care coordination.
Unlike standard Medicare benefits, SSBCI may cover services such as healthy groceries, home air-quality equipment, pest control, transportation, or home modifications. These benefits address social factors that affect health, such as nutrition, housing, and access to care.
Watch a YouTube video on the prescription payment program
SSBCI benefits are optional, meaning not every MA plan offers them. Plans also decide what types of benefits to include and who qualifies. CMS is increasing oversight to ensure these benefits are supported by evidence showing they can improve or maintain a member’s health or function.
SSBCI represents a shift in Medicare Advantage toward whole-person care; addressing more than just medical needs.
What Is VBID?
The Value-Based Insurance Design (VBID) Model, launched by the CMS Innovation Center, allowed participating Medicare Advantage plans to align cost-sharing and benefits with the clinical value of care. The goal was to lower barriers to high-value care (like preventive services or chronic disease management) while discouraging unnecessary spending.
VBID gave participating plans flexibility to reduce copays, expand supplemental benefits, and even test hospice care integration within MA. These features often targeted individuals with chronic illnesses, low income, or those living in underserved areas.
However, VBID was a demonstration model, not a permanent part of Medicare. In 2025, CMS announced it will end the VBID Model after determining that program costs to Medicare were higher than anticipated. While the model is ending, many of its design ideas; like targeted cost-sharing and flexible benefits, are expected to influence future MA benefit structures.
SSBCI vs. VBID: A Quick Comparison
| Feature | SSBCI | VBID |
|---|---|---|
| Purpose | Provide non-medical benefits to chronically ill MA members to improve health and function | Align benefit design with clinical value; lower cost-sharing for high-value care |
| Eligibility | MA enrollees with complex chronic conditions and intensive care coordination needs | Enrollees in participating MA plans, often with chronic or low-income status |
| Benefits | Groceries, home modifications, air-quality equipment, transportation, pest control | Reduced copays, targeted benefits, flexibility for chronic condition care |
| Scope | Permanent MA program option; varies by plan | CMS Innovation Model; limited participation |
| Status | Active and expanding with stronger oversight | Ends after 2025 due to high program costs |
| Impact Goal | Address social determinants of health | Improve outcomes by rewarding high-value care |
Why It Matters
Both programs reflect a growing focus on integrated, person-centered care in Medicare Advantage.
- For beneficiaries: SSBCI can provide meaningful extra help for daily living and health support, but eligibility rules apply. Not everyone in an MA plan will qualify.
- For VBID participants: The model’s end may change how some plan benefits are structured in 2026, but many innovations are expected to remain.
- For all MA enrollees: When comparing plans, look beyond premiums and copays. Review whether a plan offers SSBCI or other supplemental benefits that fit your personal needs.
Always review your plan’s Summary of Benefits and Evidence of Coverage to see if SSBCI options are available, and confirm your eligibility with the plan.
Agents stay updated on agent events and information
If you are an agent who is ready to join the team at Crowe – click here for online contract.
SSBCI and VBID have both pushed Medicare Advantage toward smarter, more holistic care. While VBID will conclude in 2025, SSBCI continues to grow; helping address many factors that shape health outcomes. Together, they represent Medicare’s evolving goal: not just to pay for medical care, but to help beneficiaries live healthier, more independent lives.
Leave a Comment