Nature-based solutions are receiving increasing attention as a cost-effective climate adaptation strategy. Horizontal levees are nature-based adaptation solutions that include a sloping wetland habitat buffer fronting a levee. They can offer a hybrid solution to reinforce traditional levees in estuarine areas-plants on the horizontal levee can provide wave attenuation benefits as well as habitat benefits, but how the design of horizontal levees influences risk of levee failure remains unquantified. We use a hydrodynamic model, XBeach non-hydrostatic (XB-NH), to assess the stability and sustainability of existing levees and determine how hybrid nature-based climate adaptation measures can reduce the risk of overtopping on levees in San Francisco Bay. We compare overtopping rates in the existing levee system and in a variety of nature-based adaptation scenarios using a range of widths and slopes of horizontal levees to assess how horizontal levees perform in reducing risk of flooding, both with present day conditions and sea level rise. We show that climate change will challenge existing levee flood defenses in San Francisco Bay and increase the risk of overtopping, and that the nature-based solution of horizontal levees can meaningfully reduce risk of overtopping while simultaneously supporting marsh habitat. Flood risk reduction and habitat provision are both maximized with more gradually sloping and wider horizontal levee designs. Results show that the risk of overtopping can be reduced by up to 30% with horizontal levees. This analysis provides insight into horizontal levee design considerations and a methodological approach to adapt levees to prepare for climate change in urban wave-exposed estuaries. We show that horizontal levees can support preparation for the projected impacts of sea level rise (SLR) while simultaneously providing new intertidal wetland habitat.