The Future of Medicare Advantage: How SSBCI Gains Appeal as VBID Phases Out in 2025

As the Medicare Advantage (MA) landscape evolves, the recent announcement of the Value-Based Insurance Design (VBID) Model ending after the 2025 calendar year has sparked industry-wide conversations about what comes next. With VBID’s flexibility and targeted benefit testing no longer available, insurers and beneficiaries alike are turning their attention to other tools within Medicare Advantage. One program poised to take on a greater role is Special Supplemental Benefits for the Chronically Ill (SSBCI).

The End of VBID: What’s Changing?

Launched in 2017, VBID allowed Medicare Advantage Organizations (MAOs) to test innovative benefit designs, such as reduced cost-sharing, targeted supplemental benefits, and rewards for beneficiaries. It offered plans flexibility to deliver tailored care, particularly for chronically ill and underserved populations.

However, CMS announced that VBID will sunset at the end of 2025 due to excess costs to the Medicare Trust Funds, estimated at $2.3 billion in 2021 and $2.2 billion in 2022. While VBID provided valuable experimentation, its costs exceeded benefits in CMS’s analysis. The loss of VBID represents the removal of an important innovation tool for insurers—particularly those focused on chronic illness management, value-based care delivery, and addressing social determinants of health (SDOH).

SSBCI: A Rising Opportunity for Plans and Beneficiaries

In the absence of VBID, Special Supplemental Benefits for the Chronically Ill (SSBCI) stand out as a program that retains the flexibility to provide non-traditional benefits within Medicare Advantage. Introduced in 2020, SSBCI allows MA plans to offer supplemental benefits that are not primarily health-related to chronically ill beneficiaries.

These benefits are designed to address broader health-related social needs, which are increasingly recognized as critical for improving health outcomes. For insurers looking to innovate post-VBID, SSBCI provides a clear opportunity to maintain focus on holistic care for high-need populations.

Why SSBCI Is Becoming More Appealing

1. Flexibility for Insurers

Unlike traditional supplemental benefits that must be health-related, SSBCI allows plans to offer non-medical services that can improve quality of life. Examples include:

• Meal delivery and groceries for individuals with dietary restrictions.

• Home modifications (e.g., grab bars, ramps) to improve safety.

• Transportation to non-medical appointments or community activities.

• Pest control services to improve living conditions.

With VBID’s termination, SSBCI becomes one of the remaining tools for targeted benefit design tailored to vulnerable populations.

2. Focus on Social Determinants of Health (SDOH)

SSBCI directly addresses social determinants of health, such as food insecurity, housing instability, and mobility challenges—factors that significantly impact chronic illness management.

• As VBID encouraged plans to prioritize SDOH, SSBCI ensures MA plans can continue this focus without disruption.

3. Chronic Condition Management

VBID allowed insurers to experiment with cost-sharing reductions for high-value care and medications, particularly for chronically ill individuals.

• SSBCI aligns well with this focus, as it exclusively targets beneficiaries with severe chronic conditions, offering services to improve overall function and reduce healthcare costs.

4. CMS Support for Innovative Care

CMS remains committed to programs that improve health equity and outcomes. SSBCI has already been widely adopted, with nearly 30% of MA plans offering at least one SSBCI benefit in 2023.

• With VBID ending, CMS may encourage greater utilization of SSBCI to maintain momentum in chronic care innovation.

What This Means for Insurers

For Medicare Advantage insurers, the phase-out of VBID means:

• A shift in strategy toward existing programs like SSBCI to maintain flexibility and differentiation.

• Increased focus on chronic care solutions that leverage non-health-related benefits to drive engagement and outcomes.

• A need to educate brokers and beneficiaries about the value of SSBCI benefits, especially in addressing day-to-day challenges for chronically ill enrollees.

What This Means for Beneficiaries

For Medicare Advantage beneficiaries, particularly those with chronic illnesses:

• SSBCI ensures continued access to targeted benefits that address practical needs beyond traditional medical care.

• Services like meal deliveries, transportation, and home modifications can improve quality of life and help manage chronic conditions effectively.

• While VBID’s loss may reduce some innovations, SSBCI remains a critical tool for MA plans to meet individual needs.

SSBCI as the Path Forward

As VBID sunsets in 2025, SSBCI is emerging as an appealing alternative for insurers seeking to offer innovative, targeted benefits within Medicare Advantage. By addressing social determinants of health and supporting chronically ill beneficiaries, SSBCI aligns with the broader goals of improving health equity, outcomes, and quality of life.

For insurers, brokers, and beneficiaries, the transition provides both challenges and opportunities—but SSBCI’s flexibility ensures that Medicare Advantage can continue to evolve in meaningful ways.