What to know about 2026 OTC, healthy food and utility benefit changes
Published by Medicare Made Clear®
There will be notable changes to certain plans in 2026. One of the biggest industry-wide changes applies to Dual Special Needs plan (D-SNP) members. While change may feel intimidating, you don’t need to navigate it alone. UnitedHealthcare is here to help you understand your coverage now and as your needs change.
Below are answers to some of the most frequently asked questions related to the upcoming over-the-counter (OTC), healthy food and utility benefit changes.
What’s changing with the over-the-counter (OTC), healthy food and utility benefit in 2026?
Through 2025, UnitedHealthcare Dual Special Needs Plan (D-SNP) members receive a monthly credit to help pay for OTC products, healthy food and utility bills. In 2026, members can still get the credit; however, due to an industry-wide change, members will need to have a qualifying chronic health condition to spend credits on healthy food and utilities. The good news? We expect most D-SNP members will still qualify.
Why is this change happening?
In 2026, the Centers for Medicare and Medicaid Services (CMS) is ending a program called the Value-Based Insurance Design (VBID) model. This program helped health plans give extra non-medical benefits, like credits for healthy food and utilities. Since the program is ending, UnitedHealthcare will now use the Special Supplemental Benefits for the Chronically Ill (SSBCI) program through Medicare to continue to offer these benefits.
What health conditions qualify me for healthy food and utilities?
Some common health conditions that may qualify you include:
- Chronic high blood pressure
- Diabetes
- Cardiovascular disease
- Chronic high cholesterol
- Chronic heart failure
These are just a few examples. Qualifying conditions may vary by carrier. A complete list of qualifying conditions for UnitedHealthcare plans is available on the UHC Member Portal.
How will current members qualify for healthy food and utilities?
If you’re already a UnitedHealthcare D-SNP member, we'll do our best to verify that you have a qualifying condition using the information we have. You don’t need to do anything right now. If we validate your qualifying condition, you’ll receive a confirmation letter or email notification.
If we can’t confirm a qualifying condition based on the information we have on file, we’ll send you a letter or email asking for more information. For UnitedHealthcare to obtain the additional information, you will first need to go online or call us to self-indicate a condition. Then, we’ll work with your treating physician to verify your condition. Remember to watch for updates in your mailbox or via email.
What do new members need to do to get healthy food and utilities?
If you’re enrolling in a UnitedHealthcare Dual Special Needs plan for the first time, you may be asked to fill out the Additional Benefit Verification Form when you enroll. This form will ask you to:
- Share your qualifying condition (like diabetes or chronic high blood pressure)
- Share your treating physician’s contact information
- Complete the verification release
- This release gives us permission to access things like your claims data and other files to find any prior diagnoses that may meet the SSBCI criteria. It also allows us to work with your treating physician to confirm your condition.
From there, we may contact your physician and then send you another letter or email with next steps.
Other things to know:
UnitedHealthcare members can find the status of their verification online anytime on the UnitedHealthcare® app or member site.
You’ll still keep your UnitedHealthcare Dual Special Needs plan. You don’t need a qualifying condition to stay enrolled or to keep your full monthly credit for OTC products — it will still be added to your UnitedHealthcare UCard® every month. Plus, you can use your monthly credit on wellness support like select fitness items. If you don’t have a qualifying condition, you won’t be able to spend your credits on healthy food or to pay utility bills in 2026.
If we can’t confirm your qualifying condition, we’ll send you a letter or email. If you think you should qualify, you’ll need to either go online or call us. Contact information will be included in the letter.
We’ll ask for:
- Information about your health condition
- Your treating physician’s name and contact info
- Permission to contact your physician to confirm your condition
Once we have this, we’ll work with your treating physician to complete the verification process and let you know if you qualify.
No. This change affects all insurance companies that offer Dual Special Needs (D-SNP) plans — not just UnitedHealthcare. Even with this change, we are using the SSBCI program to allow credits to continue being used for healthy food and utility bills in 2026 for members who qualify.
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