Aetna 2027 SSBCI Changes: What Agents Need to Know Before AEP

New eligibility verification requirements will impact how the Extra Supports Wallet is explained, accessed, and discussed with members in 2027. Get prepared now with Aetna’s upcoming broker trainings.

Aetna Medicare agents have an important update to prepare for as we head toward the 2027 selling season.

For 2027, Special Supplemental Benefits for the Chronically Ill (SSBCI) eligibility must be verified before funds can be added to Aetna’s Extra Supports Wallet or Extra Supports High Value Provider Wallet. Aetna notes that this is an industry-wide requirement resulting from clarification in the 2026 Final Rule.

That means understanding who may qualify, which benefits require eligibility verification, and what agents can and cannot do during the process will be especially important when discussing 2027 benefits with clients.

What’s Changing for 2027?

Aetna’s Extra Supports Wallet is available to eligible members through the Extra Benefits Card and can help pay for items and services such as healthy foods, personal care items, utilities, and transportation. However, these benefits cannot simply be loaded based on plan enrollment alone. The member must first meet the applicable SSBCI eligibility requirements.

To qualify, Aetna states that a member must meet CMS’s three-prong eligibility criteria:

• Be diagnosed with one or more qualifying chronic conditions

• Be at high risk for hospitalization or other adverse health outcomes

• Need intensive care coordination

One of the most important points for brokers: agents cannot determine or verify whether a member qualifies. Aetna is solely responsible for making the final eligibility determination.

This distinction will be critical when presenting plans and setting appropriate expectations with clients during AEP.

Not Every Extra Benefits Card Wallet Is Affected

Agents should also understand what is not changing.

According to Aetna, this eligibility clarification does not impact the OTC or Medical Expense Wallet benefits, which do not require the same SSBCI eligibility determination. The Extra Supports Wallet and High Value Provider-related wallet benefits will continue to be available to members who meet the appropriate eligibility criteria.

Depending on the plan, additional requirements may also apply. For example, certain LIS plans require the member to qualify for Extra Help in addition to meeting the SSBCI criteria. Members seeking the Extra Supports High Value Provider Wallet may also need to select a qualifying High Value Provider as their PCP of record.

Agents Still Play an Important Role

Although agents cannot verify SSBCI eligibility, you can help members understand how to support the process.

Aetna recommends encouraging members to complete an accurate Health Risk Assessment (HRA) after enrollment. The HRA is one of several sources Aetna may use when determining eligibility, along with medical and pharmacy claims, care management information, Healthy Home Visit information, and provider attestation.

That makes education especially important. Helping clients understand that certain benefits are dependent upon eligibility, not automatically guaranteed simply because they enroll in a particular plan, can help avoid confusion after enrollment.

Get Trained Before the 2027 Selling Season

Aetna is offering national “SSBCI and Extra Supports Wallet Changes for 2027” training webinars to help brokers understand the new requirements and prepare for member questions. Additional broker resources are also expected ahead of AEP.

Don’t wait until AEP to learn how these changes work. Take advantage of an upcoming training session so you can confidently explain 2027 benefits, properly set expectations, and guide your Aetna Medicare clients through the new eligibility process.

REGISTER FOR AN AETNA SSBCI TRAINING

Register for a “SSBCI and Extra Supports Wallet Changes for 2027” webinar that fits your schedule.

Know the changes now. Set the right expectations later. Be ready for AEP.