Does Medicare Pay for Home Care in Maryland?

The Short Answer: Medicare Covers Home Health, Not Home Care

This distinction trips up almost every family navigating elder care for the first time. Medicare uses the terms "home health" and "home care" to mean two fundamentally different things, and Maryland's provider licensing system reinforces the split.

Home health is short-term, medically intensive care ordered by a physician for homebound patients. Medicare covers it at 100% with no copay. It includes skilled nursing visits, physical therapy, occupational therapy, speech therapy, and limited home health aide services — but only while the skilled treatment is active.

Home care is ongoing, non-medical personal assistance — bathing, dressing, meal preparation, medication reminders, companionship, and daily supervision. Medicare does not cover this. Not partially. Not temporarily. Not at all.

If your parent needs someone to help them bathe every morning, prepare meals, and make sure they take their medications, Medicare will not pay for it. That kind of daily assistance must come through Medicaid, state-funded programs like SOAR, or private payment.

What Medicare Home Health Actually Covers

To receive Medicare-covered home health in Maryland, your parent must meet all of these criteria:

Homebound status. Your parent must be "homebound," meaning leaving home requires a taxing effort, the assistance of another person, or the use of assistive devices like a wheelchair or walker. Leaving home for medical appointments, religious services, or occasional short outings does not disqualify them.

Physician order. A doctor must certify that your parent needs skilled medical care at home and establish a plan of care.

Skilled need. The care must involve skilled nursing (wound care, IV management, injections), physical therapy, occupational therapy, or speech therapy. A home health aide can provide personal care only during the same period that skilled services are being delivered — and even then, the aide visits are limited to what the skilled care plan requires.

Part-time and intermittent. Medicare home health is limited to fewer than 8 hours per day and 28 hours per week in most cases. This is not full-time coverage.

When all criteria are met, Medicare Part B covers 100% of the cost with no deductible or copay for the home health services themselves.

How Long Medicare Home Health Lasts

Medicare home health coverage continues as long as your parent remains homebound, the doctor recertifies the skilled care need (every 60 days), and the therapy is producing measurable progress.

Once the skilled need ends — the wound heals, rehabilitation goals are met, the condition stabilizes — Medicare stops covering home health visits. There is no fixed day limit, but the practical duration is typically weeks to a few months.

After Medicare home health ends, your parent may still need daily assistance. This is the gap where families get stuck: they assumed Medicare would transition to long-term coverage, and instead it simply stops.

Maryland's Provider Licensing Split

Maryland reinforces the home health vs. home care distinction through its provider licensing:

Home Health Agencies (HHAs) are licensed under COMAR 10.07.10 to deliver physician-ordered skilled medical services. HHAs employ nurses, therapists, and home health aides. New HHAs must secure a Certificate of Need from the Maryland Health Care Commission before receiving a license.

Residential Service Agencies (RSAs) are licensed under COMAR 10.07.05 to deliver non-medical personal care, companion services, and homemaker services. RSAs can provide skilled nursing if they employ an RN, but their primary role is daily custodial support. RSAs do not require a Certificate of Need.

When you are searching for home care providers in Maryland, you are usually looking for an RSA. When Medicare is paying for post-hospital skilled services, a Home Health Agency provides those.

Medicare SNF Coverage: The 100-Day Limit

After a qualifying hospital stay of at least three consecutive inpatient days (observation status does not count), Medicare Part A covers skilled nursing facility (SNF) care for up to 100 days per benefit period:

• Days 1–20: Medicare covers 100%
• Days 21–100: The patient pays a daily coinsurance of $209.50 (2025 rate)
• Day 101+: Medicare coverage ends entirely

Many families discover these limits during a parent's first post-hospital rehabilitation stay. When Medicare coverage ends and the parent is not yet ready to return home safely, the family faces an immediate decision about private pay, Medicaid eligibility, or community-based alternatives.

What Covers the Gap

For ongoing personal care after Medicare home health ends (or for families whose parent never needed skilled care — just daily help), Maryland offers several pathways:

Community First Choice (CFC) — Medicaid state plan entitlement, no waitlist. Covers personal care, nurse monitoring, emergency response, and home modifications. Financial eligibility: $2,500 asset limit, $350/month income (or medically needy spend-down).

Community Personal Assistance Services (CPAS) — lower clinical threshold than CFC, covers basic personal care for those needing help with at least one ADL.

Community Options Waiver (COW) — broader services including medical day care and assisted living, but has a waitlist of 20,000+ people.

SOAR — state-funded gap-filling for moderate-income seniors aged 62+ with income under $4,358/month and assets under $20,064.

Private pay — hire an RSA directly. Median rate in Maryland is $35/hour.

The transition from Medicare-covered home health to one of these longer-term pathways is the most common planning gap Maryland families face. The Maryland Home Care, Waivers & Support Guide covers this transition step by step, including how to apply for Medicaid programs before Medicare coverage runs out.

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