SAFE through Medicare Act
- Sponsor
- Sen. Markey, Edward J. [D-MA]
- Committees
- Finance Committee (primary)
- Last action
- Apr 21, 2026
Bottom line
The SAFE through Medicare Act proposes to use Medicare to fund home modifications that protect vulnerable beneficiaries from the health impacts of climate and manmade disasters, covering all costs for eligible individuals.
What it actually does
This bill expands Medicare coverage to include "medically necessary home resiliency services" for individuals determined to be "medically at-risk" in the event of climate or manmade disasters. It specifies that these services, such as heat pumps, solar batteries for medical equipment, and energy-efficient cold storage, would be covered at 100 percent of the cost, with no out-of-pocket expenses for beneficiaries. The Secretary of Health and Human Services is tasked with establishing a process to define who is medically at-risk and what services are medically necessary, considering various factors like geography, medical reliance on equipment, and chronic conditions.
Proponents argue
Proponents argue that this bill is a crucial step in protecting the most vulnerable Medicare beneficiaries from the increasing threats posed by climate change and other disasters. They contend that proactive investment in home resiliency can prevent costly emergency room visits, hospitalizations, and even deaths during extreme weather events or power outages, ultimately saving lives and reducing overall healthcare expenditures. Supporters also highlight the equity aspect, ensuring that low-income seniors and individuals with disabilities can afford necessary home modifications to safeguard their health.
Opponents contend
Opponents may raise concerns about the potential for significant new costs to the Medicare program, arguing that expanding coverage for home modifications could lead to an unsustainable financial burden. Critics might also question the administrative feasibility and potential for fraud or abuse in determining who is "medically at-risk" and what constitutes "medically necessary" home resiliency services. Some may argue that such services fall outside the traditional scope of medical care and should be addressed through other federal or state programs, rather than Medicare.
The bill text is concise and straightforward, making it accessible for a quick read and initial evaluation by an informed reader.
Section 2(a)(1) and (2), amending Section 1861(s)(2) and adding (ooo) of the Social Security Act
Medicare Coverage of Home Resiliency Services
This provision adds "home resiliency services" as a new covered benefit under Medicare Part B. These services are specifically for individuals who are determined to be "medically at-risk" during climate or manmade disasters. Examples include heat pumps for those vulnerable to extreme temperatures, solar batteries for individuals relying on electrical medical equipment, and energy-efficient cold storage for heat-sensitive medical supplies. The services would be covered starting January 1, 2027.
Supporters argue
Supporters argue that this provision directly addresses a critical gap in healthcare, allowing Medicare to cover essential preventative measures that protect vulnerable populations from disaster-related health crises. They believe it will save lives, reduce emergency medical costs, and improve the quality of life for seniors and people with disabilities by enabling them to safely shelter in place during emergencies.
Critics contend
Critics may contend that this expansion broadens Medicare's scope beyond traditional medical care into home infrastructure, potentially setting a precedent for further expansions that could strain the program's finances. They might also argue that the definition of "medically necessary" for home resiliency could be subjective and difficult to administer consistently, leading to inefficiencies or inappropriate expenditures.
Tradeoffs
The provision balances the immediate costs of expanding Medicare benefits against the potential long-term savings from preventing disaster-related health emergencies. It also navigates the tension between providing comprehensive support for vulnerable individuals and maintaining the traditional boundaries of Medicare coverage.
Section 2(a)(2), adding Section 1861(ooo)(2) of the Social Security Act
Determination of Medically At-Risk Individuals
This section mandates that the Secretary of Health and Human Services, in collaboration with the National Institutes of Health (NIH), the Centers for Medicare & Medicaid Services (CMS), and the National Oceanic and Atmospheric Administration (NOAA), must create a process to identify individuals who are "medically at-risk" during climate or manmade disasters. This determination process must consider factors such as local climate risks, regional disaster history and future predictions (over 20 years), a person's reliance on medical equipment or supplies sensitive to environmental factors or power loss, and existing chronic medical conditions or disabilities.
Section 2(b), amending Section 1833(a)(1) of the Social Security Act
100 Percent Payment for Home Resiliency Services
This provision specifies that Medicare will pay 100 percent of the cost for covered home resiliency services. This means that eligible beneficiaries will not have any co-payments, deductibles, or other out-of-pocket expenses for these services. The payment amount will be the lesser of the actual charge for the services or an amount determined under a fee schedule established by the Secretary.
The effective date for coverage of home resiliency services is specified as "furnished on or after January 1, 2027."
Section 2(a)(2), adding Section 1861(ooo)(1)(A) of the Social Security Act
Why it matters:This is standard legislative practice to integrate effective dates directly into the definitions or applicability clauses of new benefits.
Case for: Setting a future effective date allows the Secretary sufficient time to establish the necessary processes, fee schedules, and interagency consultations required to implement the new benefit effectively and without undue haste.
Case against: Critics might argue that delaying the effective date means vulnerable individuals will continue to be unprotected from climate and manmade disasters for an extended period, potentially leading to preventable harm or death during that time.
Estimated impact: Delays the financial impact and health benefits of the program by approximately 9 months from the bill's introduction date.
The process for determining 'medically at-risk' individuals must consider 'the regional history of disaster or climate hazards and infrastructure failure in the preceding 20 years or the forward-looking predicted risk of disaster or climate hazards and infrastructure failure in the next 20 years.'
Section 2(a)(2), adding Section 1861(ooo)(2) of the Social Security Act
Why it matters:This is a technical detail for how the risk assessment should be conducted, which is typically placed within the operational instructions for an agency.
Case for: Proponents would argue that a 20-year historical and forward-looking assessment provides a robust, data-driven basis for identifying high-risk areas and ensuring that resources are allocated effectively to regions most vulnerable to future disasters.
Case against: Opponents might suggest that a 20-year lookback/lookforward period could be overly complex to implement and maintain, potentially leading to outdated or inaccurate risk assessments if climate patterns change more rapidly than predicted. They might also question the reliability of 20-year forward-looking predictions for infrastructure failure.
Estimated impact: Establishes a specific, long-term data requirement for risk assessment, influencing the geographic and demographic targeting of services.