SSBCI for New York State Medicare

There are more people enrolling in Medicare Advantage (MA) and Dual Advantage (D-SNP) programs across New York who have complex medical demands and social risk factors. 

Recently, CMS permitted MA plans like Wellcare to provide enhanced supplemental benefits to members who met specific clinical criteria in an effort to enhance clinical outcomes.

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Special Supplemental Benefits for the Chronically Ill (SSBCI)

Since the start of the COVID-19 pandemic, Wellcare has been actively addressing socioeconomic determinants of health, and delivering whole-person care, which has never been more essential for Medicare beneficiaries.  

These advantages aid in addressing social determinants of health such lack of access to food, transportation, utilities, and more. For more information on SSBCI, download the Implementing Supplemental Benefits for Chronically Ill Enrollees PDF resource, provided by Medicare Drug & Health Plan Contract Administration Group.

 

Value Based Insurance Design (VBID)

The Value Based Insurance Design (VBID) Model is a program that allows participating Medicare Advantage insurers to reduce cost sharing or provide additional supplemental benefits for targeted enrollees based on chronic condition or socioeconomic status.

In 2023, Centene will offer a VBID model targeting the low-income (LIS) population. The model intends to address socioeconomic barriers to health and wellness on Dual Special Needs Plans (D-SNPs).


The VBID model will include the following elements:

  • Part D Reduced Cost Sharing – LIS members in all phases will receive Part D drugs at a $0 copay and deductible
  • Healthy Food Card – LIS members will receive an allowance per month (either $25 or $50, varying by plan) to purchase healthy foods
  • Wellness and Healthcare Planning (WHP) -Education on WHP services, including Advance Care Planning

 

 

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In 2022-2023, Wellcare is offering a wide range of innovative SSBCI benefits including:

  • Flex Card for Utilities Payment Assistance – Wellcare will be offering a supplemental Flex Card for utility payments, a rising problem for the financially insecure population.  A pre-loaded Visa debit card with $50 to $125 will be given to eligible members. This card can be used to pay for qualifying utilities like electric, gas, sewage, and water as well as for telecommunications services and cable or other pay television.

 

  • Helper Bees Care Concierge - Wellcare, in collaboration with healthAlign, will provide this cutting-edge new benefit, giving members and their carers the freedom to tailor their care and take care of their changing requirements all year long. To better serve members' requirements, credits can be used for any combination of a la carte services, such as pest treatment, meal delivery, home modification, and in-home support.

 

  • On-Demand Grocery Delivery & Animal Support Services - Wellcare, in collaboration with Shipt, is providing members with access to free, same-day grocery delivery as well as service animal support, which includes delivery of supplies for a service animal that has been granted plan approval.  The benefits give $50 to $100 per month for food and $50 per month for plan-approved items for an Americans with Disabilities Act (ADA) service dog.  Wellcare will also cover the yearly membership fee ($99).

 

  • Therapeutic Robotic Companion Pet - Wellcare will also provide a robotic companion pet that offers the therapeutic benefits of pets without the costs or upkeep of a real animal. Through responsive interaction, the robotic pet—a realistic cat or dog—could lessen depressive symptoms and slow cognitive decline. Depending on availability, eligible members may choose either a cat or a dog as their therapeutic pet companion.

 

Additional benefits include non-medical transportation to locations like churches, gyms, and supermarkets as well as quarterly allowances that can be used to purchase durable medical equipment (DME), such as grab bars, non-slip mats, or air purifiers, or assistance devices like air conditioners, subject to availability.

 

 

 

Additional Information

Wellcare is the Medicare brand for Centene Corporation, an HMO, PPO, PFFS, PDP plan with a Medicare contract and is an approved Part D Sponsor. Our D-SNP plans have a contract with the state Medicaid program. Enrollment in our plans depends on contract renewal.

From October 1 to March 31, you can call us 7 days a week from 8 a.m. to 8 p.m. From April 1 to September 30, you can call us Monday through Friday from 8 a.m. to 8 p.m. A messaging system is used after hours, weekends and on federal holidays.

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Last Updated 10.1.2022