The SAFE Act expands Medicare coverage for physical and occupational therapy during wellness visits and initial exams for elderly patients at risk of falling.
Jim Justice
Senator
WV
The Stopping Addiction and Falls for the Elderly (SAFE) Act expands Medicare coverage to include physical and occupational therapy during Annual Wellness Visits and Initial Preventive Physical Exams for seniors at risk of falling. This aims to provide preventative care by covering falls risk assessments and fall prevention services for eligible patients. Additionally, the bill mandates annual reporting to Congress on fall incidents and resulting injuries among Medicare beneficiaries aged 65 and older.
New SAFE Act Expands Medicare for Seniors: Physical Therapy Covered After a Fall, Starting 2026
The Stopping Addiction and Falls for the Elderly Act, or the SAFE Act, is focused on a problem that impacts millions of families: senior falls. This bill is essentially making a proactive move by expanding what Medicare covers for fall prevention, but only for those who have recently had a scare.
The New Rule: PT/OT After a Slip-Up
Starting January 1, 2026, if you are on Medicare, the rules for your Annual Wellness Visit (AWV) and your Initial Preventive Physical Exam (IPPE) are changing. Currently, these visits focus on general preventative care, but the SAFE Act specifically adds coverage for physical therapy (PT) and occupational therapy (OT) services during these appointments, but there’s a catch: you must have fallen in the previous calendar year.
Think of it this way: Medicare is saying, “Okay, you fell last year, so now you’re officially high-risk.” If a doctor confirms that prior fall, the AWV can now include a dedicated falls risk assessment and prevention services performed by a physical therapist or occupational therapist (SEC. 2). This is a big deal because it means that someone who had a bad slip in 2025 will be able to get specialized therapy services covered during their 2026 wellness check, without having to wait for a separate referral or diagnosis that might require a higher copay or deductible. It’s about getting preventative care when it’s most needed—right after a warning sign.
Who Benefits and Who Pays?
This change is a clear win for seniors who have had a fall and for the physical and occupational therapists who specialize in geriatric care. For a senior who is now nervous about walking up stairs or getting out of bed, this coverage offers an accessible way to get professional help to regain strength and balance, reducing the chance of a more serious fall later.
However, expanding covered services means increased utilization, which translates to higher costs for the Medicare system and, ultimately, the taxpayers who fund it. Also, providers—the doctors and clinics—will need to adjust their internal systems to properly document and bill for these new services, which always adds a layer of administrative complexity. The benefit is strictly limited to those who have already fallen, potentially missing many high-risk seniors who could benefit from proactive assessment before their first fall (SEC. 2).
Tracking the Data: What’s Working?
Beyond expanding coverage, the SAFE Act also mandates better data collection. Starting in 2027, the Secretary of Health and Human Services (HHS) must send an annual report to Congress detailing the number of people aged 65 and older who experienced a fall in the previous year and required medical treatment for their injuries (SEC. 3).
This isn’t just bureaucratic paperwork. By requiring HHS to track these numbers year over year and report on the trends, Congress is setting up a feedback loop. They want to know if these prevention efforts—like the expanded PT/OT coverage—are actually moving the needle on senior safety. It’s a necessary step to ensure that the policy changes are having the intended real-world impact, giving us better insight into how often falls are happening and how much they are costing the healthcare system.