What Medicare Advantage plan enrollees need to know about the end of VBID

The Centers for Medicare and Medicaid Services (CMS) announced the end of the Value-Based Insurance Design (VBID) after 2025. Many Medicare Advantage (Part C) plans use VBID to offer supplemental benefits, like a monthly credit to pay for Healthy Foods or home utility bills, or reduce the cost of prescription drugs to $0 for people who qualify for financial assistance through the Extra Help program. Fortunately, CMS allows Medicare Advantage plans to use other programs, like Special Supplemental Benefits for the Chronically Ill (SSBCI) to offer similar benefits in 2026.¹

VBID, or Value-Based Insurance Design, was created by CMS in 2017. The program was meant to lower costs and improve care. VBID allowed Medicare Advantage plans to offer non-medical benefits, like food and housing support. It should be noted that special needs plans, like Dual Eligible Special Needs plans (D-SNPs), are considered types of Medicare Advantage (Part C) plans.²

Through VBID, plans were able to better support chronically ill and underserved members. These benefits generally applied to plan members with low incomes or in underserved areas. VBID also enabled Medicare Advantage plans to offer $0 cost sharing for prescription drugs.

SSBCI stands for Special Supplemental Benefits for the Chronically Ill. Introduced in 2019, SSBCI is another benefits program for Medicare Advantage plans, including D-SNPs. Like VBID, SSBCI allows Medicare Advantage plans to offer supplemental and non-medical benefits.³

These benefits are for members with complex chronic conditions who are at a high risk of hospitalization and need intensive care coordination. Complex chronic conditions include cancer, chronic heart failure, and diabetes.

Unlike VBID, SSBCI does not include benefits related to prescription drugs or Part D.

All Medicare Advantage (Part C) plans offer the same benefits as original Medicare (Parts A and B). Anything beyond this is called a supplemental benefit. In the past, supplemental benefits have been primarily health-related.These include dental, vision, and hearing benefits offered by many Medicare Advantage (Part C), including Dual Special Needs plans.

Medicare Advantage plans have also been able to offer expanded health-related benefits. These benefits include gym memberships and help with paying for over-the-counter (OTC) health and wellness products.

VBID expanded the definition of health-related benefits even further and allowed Medicare Advantage plans to offer non-medical benefits to help with social needs like paying for healthy food, transportation, and housing assistance benefits.

With SSBCI remaining, Medicare Advantage plans can continue to offer some of the non-medical benefits previously offered through VBID. Eligibility, however, will be based on proof of a qualifying chronic illness.

Unfortunately, SSBCI will not allow Medicare Advantage plans to offer $0 cost sharing for prescription drugs in 2026. For those with low income, you may continue to benefit from reduced costs through the federal Extra Help program (low-income subsidy) and the Inflation Reduction Act (IRA), which also caps prescription drug spending at $2,100 in 2026.

If you have a Medicare Advantage plan, including a D-SNP or other special needs plan, know that some benefits may change, and some may not be available in 2026. You may need to prove eligibility to access non-medical benefits.

Before the Annual Enrollment Period (AEP) begins on October 15, your plan will send an Annual Notice of Change letter. This letter will include information about your current benefits and what’s changing in 2026.

As the 2026 Annual Enrollment Period nears, review your plan’s benefits and think through your health priorities and financial needs. If you decide your plan no longer meets your needs, you can shop for plans or contact a local agent to learn about plans and coverage.