Difficulties with UHC Healthy Food Assistance

[EricW236758]

Without going into a ton of details, here is a quick outline of the problem I'm having with UHC.

I have a Dual Complete plan with UHC, and when I first joined UHC in mid-2025, I was able to use my UHC Card to purchase healthy foods.  My wife is currently being treated for stage three breast cancer, and the ability to buy healthy food was a great blessing to us.  

However, UHC took this option away from me on January 1st of 2026, and when I called to ask them about it, they told me that I would have to have a form known as the SSBCI Verification Form signed by a doctor, and then they would return healthy food assistance to me.  

Last Friday I took the SSBCI Verification Form to a doctor's appointment with me, but when I showed it to the medical assistant, she acted like I showed her a poisonous snake, and she was very adamant that no one at their facility would be willing to sign my form me for me.  I explained to the medical assistant that I had a folder full of doctor signed reports, going back to the 1970s, stating that I have been diagnose with schizophrenia and Aspergers Syndrome, but she was not interested in seeing the reports I had with me, and I could not get my verification form signed that day.

After that I went back home and began calling doctors listed on the UHC website, but all of them told me the same thing, they could not sign my SSBCI Verification Form, and that I would have to try another facility.

In the meanwhile, I've been on SSDI since 2012, due to my above disabilities, and I've been unable to return to work since then.  Also, our rent went up $200 a month in the past year, and we are really suffering.  My wife's oncologist has told us that it is important that she maintain a healthy diet, but we are now unable to afford fresh fruits and vegetables on a regular basis, and now we are stuck eating low quality processed foods to avoid hunger.  Neither of us smokes or drinks, so we are not wasting money on frivolous things, but we are now somewhat poor in our senior years. 

I sincerely believe that no reasonable person would doubt that I'm disabled, I have a ton of proof indicating my disabilities, but for some reason I cannot get my SSBCI Verification Form signed by anyone, and thus I cannot reestablish my food assistance with UHC.  

UHC relies heavily upon AI and call centers located overseas, and thus far I have not been able to speak with a real person at UHC about this issue. If anyone has any advice, I would greatly appreciate it.  

[GailL1 · Accepted solution]

@EricW236758 

Read what I wrote before for a complete explanation of the SSBCI but I have done some more checking with the Pros and it isn’t just that one has one or more or these chronic conditions, it is also the severity of them also.

VIVA MEDICARE - What is SSBCI (Special Supplemental Benefits for the Chronically Ill)? 

NOTE:  

How do members qualify for SSBCI?

For a member to qualify for SSBCI, the member must meet all of the following three criteria:

1. Has one or more of the chronic health conditions shown at the bottom of this page

2.  Has a high risk of hospitalization or adverse health outcomes

3. Requires intensive care coordination

That maybe some of the problem with getting your providers to sign off on your chronic conditions - perhaps you are managing them well.  

[RN362636]

What is bothersome to me is that UCH most likely has the medical records that they could look at themselves! 

[GailL1]

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@RN362636 wrote:

What is bothersome to me is that UCH most likely has the medical records that they could look at themselves! 

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But that isn’t what their job is, in this case.  The CMS rules and the form that the provider has to complete is specific on the chronic conditions that are applicable .  

It is also a tracking mechanism for CMS on getting the proof (or lack thereof) that benefits like these are not spent recklessly and have real value improving health for this population of Medicare beneficairies (the dual eligibles with these multiple chronic conditions). 

[EricW236758]

Well, if I could get a healthcare professional to look at me, and also look at my medical records, then I'm sure that I would have no problem meeting the above guidelines. 

Also, UHC sent me an outline of changes to my plan back in November of last year, but they were extremely vague about the upcoming changes to the food assistance, and they actually buried that piece of information deep within a section of the booklet having to do with changes to prescription benefits.  Well, it sounds like the system is broken, and my I'm just not going to be able to get my food assistance back, even though I qualify for it. 

[RN362636]

Unfortunately, a lot of Advantage plans are dropping their perks that lured so many into those plans. It is all about increasing company profits. Thise perks were just that, they were not promises. Depending upon your income you might be able to qualify for SNAP food benefits. I don't know your age but I would consider talking to someone at your local Area On Aging or similar office to see if they can assist you. Another thought is to contact a local food bank. 

[GailL1]

@RN362636 

In this case, CMS actually stopped the program effective for 01/2026 - it was a test program anyway since 2019 to see if givig these extra benefits would improve health.  It did not overall.

So they kept some of the extra benefits for those in areas where there are low medical providers.  Those covered have to have one or more of pretty extreme chronic conditions and their PCP has to sign off on them having these before their plan is approved. 

It is this last part that @EricW236758 is having a problem with - getting his providers to sign off on his conditions so he can send it to his MA insurer. 

[RN362636]

Like I said, they were perks, not promises. In all honesty, I really look at them as bait and switch. Get people to sign up for an Advantage plan mostly because of all of the perks and then take them away to increase profits per KFF and other sources. Unfortunately, many people have gone past the point of no return by having an Advantage plan for longer than one year which makes them have to go thru medical underwriting to switch to a Medicare Supplement. Those with any significant medical issue will most likely not qualify. There hope then often rests upon a plan cancelling like the 600,000 on the United Healthcare PPO plan. Then they can get a traditional supplement without medical underwriting. It seems to me that many Advantage plans have no advantage.

[TRL1111]

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@RN362636 wrote:

 It seems to me that many Advantage plans have no advantage.

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I think the very low premium, often $0, is an advantage. It comes with trade-offs, of course, but at least it exists as an alternative for people who can't afford a Medigap supplement, even a high-deductible one.

[RN362636]

This is true. One tradeoff is that the co-pays and possible maximum out of pocket maximum for the year can be more than the cost of premiums for a supplement. This is especially true if one has a serious illness and requires ongoing treatments. How would someone who can not afford a supplement afford the maximum out of pocket? It is a dilemma. 

[GailL1]

@RN362636 @TRL1111 

Just for some clarity here - 

The BIden Administration cancelled the VBID (Value Based Insurance Design) back in 2023/2024 - it was completely discontinued in January 2026.  This was the program under which many MA enrollees got more extra benefits(non-medical) like OTC products, food, some cash payments for different things like utilities and the like.  This was under the hypothesis that you treat the whole person to make them healthy.  It didn’t work - the stats showed that there was no change in the health of these participants even though I am sure that these extra benefits helped them monetarily in their day to day lives.  As you know this VBID model of a MA plan was opened to any beneficiary within the geographical area where they were offered.  The program became more of a selling point that a benefit for MA plans.  It also cost them money as well as the overall program - so they did not see any cost savings either.

BUT there is value to giving benefits like this to those that are  way under the income scale - so while for most beneficiaries this model of MA plans has been discontinued - it was continued and actually expanded somewhat for those who are DUAL eligibile (get both Medicare and Medicaid) AND have certain special needs - both criteria has to be met to qualify.

In this case, these beneficiaries have to have their docs sign a form indicating the type and number of chronic conditions that are applicable to them.  The OP of this thread had such a problem since he had problems getting his providers to sign off on his many conditions - why, I do not know.

UHC.com - What Medicare Advantage plan enrollees need to know about the end of VBID 

Just wanted to make sure everybody was understanding what has transpired in this program - Now it its not for just anybody that has access to such a plan - now it is specifically designed for those DUAL eligibles with (spectific) special needs in order to help them out more in the Special Supplemental Benefits for the Chronically Ill - plans just for them, managed by the MA insurer.

[GailL1]

Again, sorry for all these problems -

The way it went - CMS did away with the Value Based Insurance Design - it was a special test program for awhile, that did not pan out with cost savings as they and the MA plans thought.  This cancellation of the VBID was in the works for a whole year before it was cancelled.

CMS.gov-12/16/2024 - Medicare Advantage Value-Based Insurance Design (VBID) Model to End after Calen... 

I bet that you just renewed with the same plan during open enrollment in the fall of 2025.  Please start reading those notices that you get from your insurer that you get during this time because they are suppose to send you an Annual Notice of Change so that you can weight the changes and see if you want to re-up with that plan or pick another that better fits your needs.  This change to the new Special Supplemental Benefits for the Chronically Ill (SSBCI) should have been covered in that ANOC (annual notice of change). 

United Healtcare described this change on their site:

United Healthcare-Medicare Made Clear - What Medicare Advantage plan enrollees need to know about th... 

Now those benefits (and actually more, I think) are only offered under the Special Supplemental Benefits for the Chronically Ill (SSBCI).  SSBCI allows Medicare Advantage plans to offer non-medical, supplemental benefits to members with specific high-need, chronic conditions.

In order to be eligible for these benefits a person’s doctor has to attest that they have certain chronic diseases.  (more than one).  

Here is the The Electronic Code of Federal Regulations (eCFR) that describes this new program for the chronically ill  [ (see (f) ]

Electronic Code of Federal Regulations (eCRF) - (f) Special supplemental benefits for the chronicall... Title 42 Chapter IV Subchapter B Part 422 Subpart C -  § 422.102

It describes in detail who qualifies and the roll of the MA plan.  The law.

Remember I am NOT a Pro but one may have had to do all this chronic illness validation with their plan and their provider before open enrollment ended - otherwise, you just got the standard type plan without the supplemental benefits offered to those who qualify for the Special Supplemental Benefits for the Chronically Ill (SSBCI).

This describes theses special benefits in a easy to read format 

Medical News Today - SSBCI Medicare: Special Supplemental Benefits for the Chronically Ill 

Now you will have to have these specific chronic conditions to apply but if you do, I do not understand why a doc would not sign off on these specific conditions if they have diagnosed them.  They are participants in your MA plan, right? (in-network).

Is this the form you have?   Got one or more of these conditions?

UnitedHealthcare - SSBCI verification form 

PLEASE start reading those Annual Notices of Change that you get in the fall - Medicare Advantage plans can change and you do have a period of open enrollment in the fall of each year to change if your needs change or the plan changes so it no longer meets your needs as it did the year before.  

[EricW236758]

Yes, that is the form I have, and yes the doctors I have been asking to help me are in my network,  Right now I have a diagnosis of schizophrenia, a blocked vessel in my heart, and diabetes, but I cannot get anyone to help me. Also, as you may have noticed, I have a problem with my working memory, and it is difficult for me to comprehend things, especially if I'm under stress.  The people at UHC's call center in India said that based upon my records, it should be no problem to get approved again, but so far all I have been getting is obstacles.  I have no idea why the doctors don't want to even look at this form, but my wife and I are in a bad situation. 

[RN362636]

Since your wife has stage 3 breast cancer maybe apply using her condition rather than yours? Just a thought.

[GailL1]

His wife does not have Medicare - she has Medicaid.