Medicare Advantage (MA) plans may be a better option for chronically ill patients over Original Medicare due to the availability of additional benefits, lower cost sharing, and more coordinated care. One of the most recent updates from the Centers for Medicare and Medicaid Services (CMS) related to supplemental benefits was the ability for MA plans to offer Special Supplemental Benefits for the Chronically Ill (SSBCI). Adoption of SSBCI was very limited in its first year, says the Commonwealth Fund, but more plans will offer these benefits for the 2022 plan year. This includes Aspire Health Plan’s MA plans.
What chronic conditions make you eligible for SSBCI?
If you are diagnosed with cancer, chronic heart failure, diabetes, end stage renal disease (ESRD), chronic lung disorders, chronic and disabling mental health conditions and neurologic disorders and meet certain criteria, you may be eligible for SSBCI.
What does it mean if you qualify for SSBCI?
If you qualify for SSBCI, you’re required to participate in a plan’s care management program. Members who meet the SSBCI eligibility requirements can self-refer or be identified through medical management interventions. From there, the care management team will make sure the member meets criteria for participation in SSBCI.
What SSBCI do Aspire Health Plan MA plans offer for 2022?
Aspire Health Plan members may qualify for SSBCI benefits including:
- Transportation to in-network medically necessary appointments and to obtain non-medical items related to your chronic condition
- Meals in partnership with Mom’s Meals NourishCare
- Food and produce to help members meet nutritional needs
- Indoor air quality equipment and services including temporary or portable air conditioning units, humidifiers, dehumidifiers, high-efficiency particulate air filters, or carpet cleaning to improve indoor air quality
- Social needs benefits such as access to community-based or plan-sponsored programs to address social needs
- General supports for living such as housing for chronically ill enrollees
Items and services listed above are expected to improve or maintain the overall health of the member. For more information, check out the Evidence of Coverage documents for our 2022 MA plan offerings.
How else can Medicare Advantage plans help you manage chronic conditions?
Under current rules, there is no Medicare out-of-pocket maximum for Original Medicare. This means if you have a chronic health condition or an unexpected health crisis, you could pay thousands in medical costs. All MA plans have limits on your out-of-pocket costs. This means that once you reach the out-of-pocket limit, your plan pays 100 percent of your healthcare expenses for covered medical services for the remainder of the year. CMS sets an out-of-pocket maximum standard for Medicare Advantage plans for combined in and out of network expenses each year; however, some plans may set lower limits.
Aspire Health Plan members have no-cost access to an enhanced care team including health coaches, care managers and social workers to empower and support you on your healthcare journey. To request more information, call (831) 644-7490.