S-4358-119
Read twice and referred to the Committee on Finance.
Sponsored by Edward Markey (D-MA)
What it does
This bill would add a new category of Medicare coverage called "home resiliency services" for beneficiaries determined to be medically at-risk during a climate or manmade disaster. Covered items would include heat pumps, batteries for medical equipment, and energy-efficient storage for medical supplies. Coverage would be limited to cases where these services are deemed medically necessary.
Who benefits
Medicare beneficiaries (primarily adults 65 and older, plus younger people with qualifying disabilities) who are medically at-risk during disasters — such as those dependent on powered medical equipment like ventilators, oxygen concentrators, or refrigerated medications. Manufacturers and retailers of heat pumps, batteries, and energy-efficient storage equipment who would gain a new federally reimbursed customer base. Home health and durable medical equipment suppliers who may administer or install covered items. Residents of disaster-prone regions (e.g., areas with extreme heat, hurricanes, or wildfires) who rely on Medicare.
Who is hurt
Medicare trust funds and federal taxpayers, who would bear the cost of the new benefit category. Private insurers and Medigap plan providers, who may face pressure to offer comparable coverage. Medicare beneficiaries who are not classified as "medically at-risk" and therefore would not qualify, potentially creating unequal access within the same program. Competing durable medical equipment suppliers not positioned to provide the newly covered items. States and localities that currently fund emergency preparedness assistance for vulnerable residents, who may face pressure to shift costs to Medicare.
Supporters argue
Supporters argue that Medicare beneficiaries with serious medical conditions — such as those requiring powered ventilators, oxygen equipment, or refrigerated insulin — face life-threatening risks during power outages caused by disasters, and that existing Medicare coverage does not address this gap. They contend that covering preventive home resiliency equipment is medically necessary and could reduce far more costly emergency hospitalizations and deaths, making the benefit fiscally defensible as well as humane.
Opponents argue
Opponents argue that home infrastructure items like heat pumps and energy storage systems are general household goods, not medical devices, and that expanding Medicare to cover them sets a broad precedent that could blur the program's medical purpose and open the door to further non-clinical coverage expansions. They contend that "medically at-risk" and "medically necessary" determinations for disaster preparedness equipment would be difficult to define and administer consistently, potentially creating fraud vulnerabilities and uneven access across Medicare Administrative Contractors.