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 plans used VBID to offer supplemental benefits, like a monthly credit to pay for healthy foods or home utility bills. Fortunately, other programs, like Special Supplemental Benefits for the Chronically Ill (SSBCI), offer similar benefits in 2026 and beyond.

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.¹

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.

Medicare Advantage plans, and D-SNPs are primarily affected by the end of VBID. Supplemental benefits are not offered through Medicare Supplement and Part D plans.

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.²

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 and more complex health issues.

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.

Food and utility credits will no longer be available through VBID. Instead, eligible Medicare Advantage members must have a qualifying chronic condition and more complex health needs to receive SSBCI benefits. Your plan provider will verify your chronic condition, and you should receive a confirmation letter or email.

A complete list of qualifying conditions for UnitedHealthcare plans is available on the UHC member site.

With the end of VBID, $0 cost sharing is no longer permitted through Medicare Advantage plans such as D-SNPs. Instead, members who were eligible for VBID cost sharing should explore the Part D low-income subsidy program, known as “Extra Help.”

The hospice benefit component of VBID is also no longer available. Hospice care remains covered as part of Original Medicare (Part A) and is included with Medicare Advantage plans, including D-SNPs.

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 no longer be available. You may need to prove eligibility to access non-medical benefits.

The Annual Enrollment Period (AEP) begins on October 15. You will recieve an Annual Notice of Change (ANOC) letter by September 30. This letter will include information about your current benefits and what’s changing next year.

Take the time to review your ANOC before AEP and pay close attention to what may be changing for the next year. Be sure to think through your upcoming health priorities and financial needs. If you decide your plan no longer meets your needs, you may shop for plans online or contact a local agent to learn more about plans and coverage options in your area.