Medicare pays for home health care: part-time skilled nursing or therapy that a provider orders for someone who is homebound. It does not pay for ongoing companionship, homemaker help or personal care when that is the only help a person needs. Maryland Medicaid can cover some long-term help at home through programs such as Community First Choice and the Community Options Waiver, but those have medical and financial rules and, for the waiver, a waitlist.
What Medicare covers at home
Medicare uses the term “home health services” for medical care delivered at home. According to Medicare.gov, covered services can include part-time or intermittent skilled nursing, physical and occupational therapy, speech-language services and medical social services.
A home health aide can help with things like bathing or walking, but only while the person is also getting skilled nursing or therapy. The aide visit rides along with the skilled care; it is not a stand-alone benefit.
Medicare lists several conditions:
- The person must be homebound, meaning leaving home takes considerable effort or help.
- A doctor or other provider must see the person in person, confirm the need and order the care.
- A Medicare-certified home health agency must provide it.
- The need must be part-time or intermittent. Medicare.gov says this usually means up to 8 hours a day combined, with a maximum of 28 hours a week.
When those conditions are met, Medicare.gov says the person pays nothing for covered home health services, though 20% of the approved amount applies to medical equipment after the Part B deductible.
What Medicare does not pay for
Medicare.gov is direct about the gaps. It does not pay for:
- 24-hour-a-day care at home
- Home meal delivery
- Homemaker services, like shopping and cleaning, that are unrelated to the care plan
- Custodial or personal care, such as help with bathing or dressing, when that is the only care needed
Medicare’s long-term care page adds that Medicare and most Medigap policies do not pay for long-term care, whether in a nursing home or in the community. Companion care, the kind of non-medical help described on our how it works page, falls outside Medicare.
| Type of help at home | Original Medicare | Maryland Medicaid |
|---|---|---|
| Skilled nursing or therapy, ordered by a provider, for someone homebound | Covered when Medicare’s conditions are met | Ask Maryland Medicaid about home health coverage |
| Home health aide alongside skilled care | Covered, part-time | Ask Maryland Medicaid about home health coverage |
| Personal assistance with daily activities, long term | Not covered | Possible through Community First Choice or the Community Options Waiver, if eligible |
| Companionship, errands, light housekeeping | Not covered | Generally not a stand-alone benefit; ask Maryland Access Point |
| Home-delivered meals | Not covered | Listed as a Community First Choice service, if eligible |
This table summarizes official program pages. It is not an eligibility decision; only the program itself can make one.
Medicare Advantage and Medigap
If a parent has a Medicare Advantage (Part C) plan, Medicare.gov tells members to check with the plan about home health benefits. Some plans describe extra benefits; the plan’s Evidence of Coverage is the document to read, and the member services number is on the card.
Medicare Supplement Insurance (Medigap) policies, according to Medicare.gov, generally do not pay for long-term care either.
For a free, unbiased review of a parent’s Medicare coverage, Maryland’s State Health Insurance Assistance Program (SHIP) has a Montgomery County office. SHIP counselors do not sell insurance.
Maryland Medicaid programs for help at home
Maryland Medicaid has several home and community-based programs. Two come up most often for older adults.
Community First Choice
The Maryland Department of Health says Community First Choice is for people who already have full Medicaid, live in the community and need an institutional level of care. Listed services include personal assistance, home-delivered meals, personal emergency response systems, assistive technology and supports planning. There is no age limit.
Community Options Waiver
The Community Options Waiver, also called the Home and Community-Based Options Waiver, is for adults 18 and older who need a nursing facility level of care and meet income and asset rules. The state’s waiver page describes services such as case management, assisted living services, family training, medical day care and Senior Center Plus, on top of regular Medicaid benefits.
The same page says there is a waitlist. To be added to the Community Options Waiver Registry, call Maryland Access Point at 844-627-5465; the state sends an invitation to apply when a slot opens. The page also mentions the Increased Community Services Program for some people whose income is too high for the waiver.
Financial and medical rules decide who qualifies. The state’s own advice is that the best way to find out is to apply, and options counselors can help with the application.
How to start without guessing
- Separate the medical from the non-medical. List what your parent needs: wound care or therapy, help bathing, company during the day, meals, errands. Our guide to companion care vs. personal care vs. home health explains the categories.
- Ask the doctor about home health if skilled care is needed, especially after a hospital stay. If home health is ordered, the provider should give a list of agencies serving the area.
- Call SHIP to review Medicare or Medicare Advantage coverage.
- Call the county ADRU or Maryland Access Point to ask about Medicaid programs, the waiver registry and other county services.
- Price the rest. Help that no program covers is usually paid privately or through long-term care insurance, if a policy exists. Our guide to home care costs in Montgomery County covers what to compare.
For the household side of recovery, such as meals, errands and company, see help after a hospital stay.
Common questions
Does Medicare pay for a companion or homemaker at home?
No. Medicare.gov says Medicare doesn’t pay for homemaker services unrelated to a care plan, or for personal care when that is the only care needed. Companionship is not a Medicare benefit.
How do I get on the Community Options Waiver waitlist in Maryland?
The Maryland Department of Health says to call Maryland Access Point at 844-627-5465 to be added to the Community Options Waiver Registry. The state invites people to apply when a slot opens.
Who can review my parent’s Medicare coverage for free in Montgomery County?
Maryland’s State Health Insurance Assistance Program (SHIP) has a Montgomery County office at 301-255-4250. SHIP counselors offer free, unbiased help and do not sell insurance.
Sources
- Medicare.gov: Home health services
- Medicare.gov: Long-term care
- Maryland Department of Health: Community Options Waiver
- Maryland Department of Health: Community First Choice
- Maryland Department of Aging: SHIP
- Montgomery County: Aging and Disability Resource Unit
This guide is general information, not medical, legal or financial advice. Phone numbers and programs were checked on the date shown above; confirm details with the agency before you rely on them.