2027 SSBCI Eligibility Requirements: What Agents Need to Know
Beginning in 2027, members must meet all three CMS requirements to qualify for Special Supplemental Benefits for the Chronically Ill (SSBCI).
To be eligible, a member must:
- Have a serious chronic health condition that is medically complex, life-threatening, or significantly impacts overall health and daily functioning.
- Be at high risk for hospitalization or other serious health issues due to increased risk for major medical complications.
- Require a high level of care coordination, including ongoing management and coordination among healthcare providers and services.
Key Takeaway
Meeting just one or two of these requirements is not enough. Members must satisfy all three criteria to be considered eligible for SSBCI benefits in 2027. This guidance comes directly from CMS eligibility requirements.