SSBCI: the Medicare Advantage benefits for chronically ill members that can include rides
Overview
SSBCI means special supplemental benefits for the chronically ill, an optional Medicare Advantage benefit under 42 CFR 422.102(f). A plan may cover items that are not primarily health related, including rides for errands such as grocery shopping and banking. A member qualifies only when the plan finds a complex chronic condition, a high risk of hospitalization, and a need for intensive care coordination.
On this page
SSBCI is the Medicare Advantage rule that lets a plan pay for things that are not primarily health care, such as meals, pest control and rides, when a chronically ill member’s health could improve or hold steady because of them. Most Medicare Advantage plans still do not offer these benefits, according to KFF’s 2026 analysis. For a ride company the part that counts is rides to the grocery store, the bank and other non-medical places. The other ways Medicare Advantage plans pay for rides are in Medicare Advantage transportation, and how a flex card can pay for them is in the flex card guide.
Who counts as chronically ill
A member qualifies only when the plan finds all three of these true under 42 CFR 422.102(f)(1)(i):
- The member has one or more comorbid, medically complex chronic conditions that are life threatening or significantly limit health or function.
- The member has a high risk of hospitalization or other adverse health outcomes.
- The member requires intensive care coordination.
Having a chronic condition does not settle it. The plan must show all three through a health risk assessment, a claims review or something similar. The plan must also base that finding on written, objective criteria and document every decision. From January 1, 2027, CMS’s contract year 2027 final rule, published April 6, 2026, also requires each plan to list those policies and criteria for every SSBCI on its public website.
What a plan may cover as SSBCI
The benefit must have a reasonable expectation of improving or maintaining the member’s health or overall function, and it may be something that is not primarily health related. CMS’s 2019 memo lists examples that include meals beyond a short period, food and produce, pest control, indoor air equipment, social needs programs, structural home modifications, housing support and transportation for non-medical needs.
The memo’s transportation item covers rides to get non-medical items and services, with grocery shopping and banking as its examples, and rides tied to any other SSBCI. The plan can pay the member back, arrange the ride itself or supply it directly.
The rule also bars a list of items from SSBCI, including alcohol, tobacco, life insurance, funeral expenses and hospital indemnity insurance. Rides are not on it.
Who decides eligibility
The plan decides, and the member cannot decide for themselves. In the 2026 rule CMS says that letting an enrollee certify eligibility by checking a box, with no independent determination by the plan, is not compliant. Its example is a non-medical transportation benefit paid as a gas card. Two other limits apply:
- Social needs alone are not enough. A plan may weigh social determinants of health when it picks members, but not as the only basis for eligibility.
- Rules stay fixed for the year. The plan must keep its evidentiary standards and objective criteria unchanged for the full coverage year.
With CMS approval, a plan may also offer SSBCI that is not the same for every eligible member.
What plans must show CMS and members
A plan has to back each SSBCI with evidence. By the bid submission it must hold a written bibliography of relevant research for each benefit, and CMS may decline to approve a bid if the evidence does not support the benefit. It must also keep written eligibility policies and a record of every determination, whether the member was found eligible or not.
Members see the benefit in marketing, which must carry a disclaimer under 42 CFR 422.2267(e)(34). The disclaimer says the benefits mentioned are SSBCI, names up to five qualifying chronic conditions, and says that having one of the conditions does not guarantee the benefit.
How the rides reach a ride company
How a ride company is paid depends on which route the plan uses. When the plan arranges the rides, the ride company is paid by the plan or by the vendor the plan uses. When the plan reimburses the member, the member pays for the ride, and a flex card is one way that happens. When the plan provides rides itself, it needs no outside company. A plan may also cap the benefit: CMS lets it set a maximum for each SSBCI or one combined amount, and the 2019 memo gives non-medical transportation paired with social needs benefits as its example of a combined limit. Commonwealth Care Alliance’s Senior Care Options plan lists 10 one-way non-medical rides a month within a 50-mile radius for members who qualify.
A ride company reaches this work the way it reaches other Medicare Advantage rides, through the plan’s transportation vendor or the plan itself, as the Medicare Advantage guide explains. Read the plan’s Evidence of Coverage for the cap, the booking rules and which trips count as non-medical. Each trip in HealthRide has GPS-recorded miles and timestamps, and you can export the trip log to back up the invoice you send a plan or its vendor.
Frequently asked questions
- Can any Medicare Advantage member use an SSBCI ride benefit?
- No. Only a member the plan has found to be a chronically ill enrollee can, and the plan may add limits of its own. A chronic condition by itself is not enough, because the plan must also show a high risk of hospitalization or other adverse outcomes and a need for intensive care coordination. The plan makes that finding, and a member cannot qualify by checking a box.
- How is an SSBCI ride different from a plan's regular ride benefit?
- A regular supplemental ride benefit takes members to medical appointments and is open to members of the plan. An SSBCI ride goes to non-medical places such as the grocery store or bank, or to another SSBCI the member uses, and only chronically ill members who qualify can book it. Plans often cap each benefit separately or under one combined limit.
- Where can a ride company read a plan's SSBCI rules?
- In the plan's Evidence of Coverage, which must say what is and is not covered. Starting January 1, 2027, each plan must also list the written policies and objective criteria for every SSBCI on its public website. The plan decides who qualifies.
- Do SSBCI rides come with a set limit?
- Usually, yes. CMS lets plans set a maximum coverage amount for each SSBCI or one combined amount across several. Commonwealth Care Alliance, for example, lists 10 one-way non-medical rides a month within a 50-mile radius for members who qualify. The plan's own handbook sets the real limit, so read it before you count on that work.
