Medicare Advantage grocery allowance eligibility (SSBCI)

Introduction

If you have seen ads for a “Medicare grocery allowance” or a “healthy food card,” it can sound like a guaranteed benefit. In reality, grocery allowances are optional extra benefits offered by some Medicare Advantage plans, and eligibility is usually limited to certain members who meet specific criteria.

This guide explains what SSBCI is, who may qualify, and what documentation your plan typically uses to confirm eligibility.

How Understood Care can support you
If you are managing plan paperwork, benefits questions, or confusing eligibility rules, it helps to have a clear plan for what to ask and what documents to gather. You can also compare grocery benefits plan by plan here: https://understoodcare.com/uc-articles/deep-plan-by-plan-comparisons-of-grocery-benefits

If your “flex card” also mentions utilities or living expenses, this related guide may help: https://understoodcare.com/uc-articles/flex-cards-and-grocery-benefits-that-can-also-pay-rent-or-utilities

Content

• What a Medicare Advantage grocery allowance is
• What SSBCI means and why it matters
• Who qualifies for SSBCI grocery benefits
• What proof plans usually require
• How to check your eligibility and avoid common surprises
• FAQ
• References

What a Medicare Advantage grocery allowance is

A Medicare Advantage grocery allowance is usually an extra benefit that helps you buy approved healthy foods at participating stores. Plans may deliver it through a card or account that can only be used for eligible items and retailers.

A few important points can save you time and frustration:

• Grocery allowances are not part of Original Medicare.
• Not every Medicare Advantage plan offers them.
• Even when a plan offers a grocery benefit, it may only be available to members who meet SSBCI eligibility rules or other plan criteria.

Grocery allowance vs meals vs OTC benefits

These benefits can sound similar, but they are not the same:

• Food and produce allowance (often SSBCI): An allowance for certain grocery items to support nutrition needs.
• Meals benefit: Prepared meals, sometimes after a hospital stay, sometimes beyond that depending on the plan and benefit design.
• OTC allowance: An allowance for certain over the counter health items (varies widely by plan).

Your plan documents should name the benefit category and explain who can use it.

What SSBCI means and why it matters

SSBCI stands for Special Supplemental Benefits for the Chronically Ill. Federal law and Medicare rules allow Medicare Advantage plans to offer certain supplemental benefits to eligible “chronically ill” enrollees, and those benefits can include nonmedical supports when they are expected to help maintain or improve health or overall function.

The plain language takeaway

SSBCI is not a separate government program you apply to on its own. It is a set of rules that lets Medicare Advantage plans target certain extra benefits, like food and produce support, to members who meet specific criteria.

Just having a chronic condition does not automatically mean you qualify.

Who qualifies for an SSBCI grocery allowance

Eligibility is a combination of federal requirements and your plan’s rules.

Step 1: You must be in a plan that offers the benefit

Plans decide whether to offer SSBCI benefits at all, and they must submit benefit information to Medicare for review and approval each year.

If your plan does not list a food and produce benefit (or similar wording) in its official documents, you generally will not have access to a grocery allowance through that plan.

Step 2: You must meet the federal definition of “chronically ill” for SSBCI

Medicare regulations define a chronically ill enrollee for SSBCI as someone who meets all of these:

• Has one or more medically complex chronic conditions that are life threatening or significantly limit overall health or function
• Has a high risk of hospitalization or other adverse health outcomes
• Requires intensive care coordination

This definition is important because SSBCI benefits can only be offered to members who fit it.

Step 3: You must meet your plan’s additional eligibility criteria for that specific benefit

Medicare allows plans to develop objective criteria for SSBCI eligibility, and plans are expected to document how they determine eligibility.

That means two people with the same diagnosis may not be treated the same way if the plan’s criteria look at additional factors like recent hospitalizations, functional limitations, or care coordination needs.

Plans where grocery allowances are more common

SSBCI benefits are often associated with Medicare Advantage Special Needs Plans. Medicare describes three SNP types:

• D SNP: for people with both Medicare and Medicaid
• C SNP: for people with certain severe or disabling chronic conditions
• I SNP: for people who need an institutional level of care

Grocery allowances may also exist in non SNP Medicare Advantage plans, but they are not universal.

What proof plans usually require

Many people assume they must “apply” and submit paperwork. Sometimes that is true. Often, plans use information they already have.

CMS expects plans to use objective criteria such as health risk assessments or review of claims data when determining SSBCI eligibility, and plans should describe limitations and eligibility processes in the Evidence of Coverage.

Common ways plans confirm eligibility

Plans commonly confirm SSBCI grocery eligibility in one or more of these ways:

• Automatic identification using claims and diagnoses (for example, diagnosis codes already in your records)
• Health risk assessment or care management screening that helps the plan document needs related to health and function
• Clinician confirmation when the plan needs documentation that the benefit is appropriate for your specific situation
• Plan specific criteria for the benefit category, such as nutrition related need aligned with a care plan

Because plans vary, it is reasonable to ask your plan to tell you exactly what criteria they use and what documents they accept.

Documents you may be asked to provide

If your plan does require member submitted proof, they often ask for practical documentation like:

• A current problem list or diagnosis summary from your clinician
• Recent visit notes that show how your condition affects daily function
• Recent discharge paperwork if there was a hospitalization
• A medication list (helps confirm complexity)
• A care plan or care coordination documentation when applicable

If you are a caregiver, it can help to keep a simple folder (paper or digital) with these items so you can respond quickly to requests.

If you are denied

CMS notes that requests for coverage of supplemental benefits should be treated similarly to other plan benefit requests, and plans should clearly state what is covered and the criteria in plan materials.

If the plan says you are not eligible, ask for:

• The specific reason for the decision
• The specific criteria you did not meet
• What additional documentation (if any) could change the decision
• How to request a formal review or appeal under your plan’s process

How to check your eligibility and avoid common surprises

Use the Evidence of Coverage as your source of truth

Medicare explains that your plan sends an Evidence of Coverage each year, and it includes details about what the plan covers and how it works.

When you review it, search for terms like:

• food and produce
• healthy foods
• grocery allowance
• SSBCI
• flex card
• special supplemental benefits

Call with a short script

When you call your plan (or help a loved one call), you can keep it simple:

• “Does my plan offer a food and produce or healthy foods benefit?”
• “Is it an SSBCI benefit, and what are the eligibility criteria?”
• “How do you determine if I qualify, and what proof do you use?”
• “Where is this explained in my Evidence of Coverage or Summary of Benefits?”
• “If I do not qualify today, what would need to change for eligibility?”

If you are comparing plans

The official Medicare plan comparison tool can help you see plan options in your area.

For broader cost and benefit support, Understood Care’s financial resources may also be helpful: https://understoodcare.com/uc-articles/financial-help‍

FAQ

• Is the Medicare Advantage grocery allowance the same as SSBCI?
  Often, a grocery or healthy foods benefit is offered as an SSBCI benefit, but some plans may structure food support differently. Your plan documents should state the benefit type and eligibility rules.
• Who qualifies for a healthy food card in Medicare Advantage?
  Typically, you must be enrolled in a plan that offers the benefit and meet the plan’s SSBCI eligibility criteria for a chronically ill enrollee, plus any additional plan rules for that benefit category.
• Do you have to be dual eligible to get a Medicare grocery allowance?
  Not always, but grocery benefits are commonly offered in plans designed for higher need groups, including D SNPs. Availability depends on your plan and county.
• What proof do Medicare Advantage plans require for SSBCI grocery benefits?
  Many plans use claims data and screenings they already have. If documentation is needed, plans commonly rely on diagnoses, medical records, and sometimes clinician confirmation.
• Can my plan stop or change my grocery allowance during the year?
  Plans describe benefit limits and rules in the Evidence of Coverage, and benefits can vary by plan year. Review your plan’s notices and documents each year.
• What should I do if my SSBCI grocery benefit is denied?
  Ask for the written reason, the exact criteria used, what documentation could help, and the steps for a formal review or appeal.

References

• Centers for Medicare and Medicaid Services, Implementing Supplemental Benefits for Chronically Ill Enrollees (HPMS memo, April 24, 2019)
  https://www.cms.gov/medicare/health-plans/healthplansgeninfo/downloads/supplemental_benefits_chronically_ill_hpms_042419.pdf
• eCFR, 42 CFR 422.102 Supplemental benefits, including SSBCI definition and requirements
  https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-422/subpart-C/section-422.102
• Social Security Act, Section 1852 (including expansion of supplemental benefits for chronically ill enrollees)
  https://www.ssa.gov/OP_Home/ssact/title18/1852.htm
• Social Security Administration, compilation of Public Law 115-123 (Bipartisan Budget Act of 2018), including Section 50322
  https://www.ssa.gov/OP_Home/comp2/F115-123.html
• Medicare.gov, Special Needs Plans overview
  https://www.medicare.gov/health-drug-plans/health-plans/your-health-plan-options/SNP
• Medicare.gov, Evidence of Coverage overview
  https://www.medicare.gov/basics/forms-publications-mailings/mailings/costs-and-coverage/evidence-of-coverage
• Medicare.gov, Medicare plan comparison tool
  https://www.medicare.gov/plan-compare/
• Medicare.gov, Understanding Medicare Advantage Plans (publication PDF)
  https://www.medicare.gov/publications/12026-understanding-medicare-advantage-plans.pdf
• US Government Accountability Office, Medicare Advantage: Plans Generally Offered Some Supplemental Benefits, but CMS Has Limited Data on Utilization (GAO 23-105527)
  https://www.gao.gov/assets/d23105527.pdf
• Medicare Payment Advisory Commission, Supplemental benefits in Medicare Advantage (slide deck)
  https://www.medpac.gov/wp-content/uploads/2023/10/MA-supp-benefits-MedPAC-Oct-2024-SEC.pdf
• HHS Office of Disease Prevention and Health Promotion, Food is Medicine Federal Resource Hub, Medicare Advantage health plans (includes SSBCI nutrition benefits context)
  https://odphp.health.gov/foodismedicine/federal-resource-hub/medicare-advantage-health-plans
• JAMA Health Forum, Medicare Advantage Supplemental Benefits for Dual-Eligible Beneficiaries and Recommendations for Reform (includes SSBCI context and food and produce benefits)
  https://jamanetwork.com/journals/jama-health-forum/fullarticle/2823000
• Congressional Research Service, Bipartisan Budget Act of 2018 (P.L. 115-123) brief summary (ACCESS Act)
  https://www.congress.gov/crs_external_products/R/PDF/R45126/R45126.4.pdf

This content is for education only and does not replace guidance from your local SNAP agency or EBT customer service. If you believe you’re experiencing active fraud or feel unsafe, contact local authorities right away.