Home Care vs. Home Health in Maryland (2026)

"Home care" and "home health" sound like the same service, but they're not, and in Maryland the difference is written into the licenses themselves. Home health is skilled, doctor-ordered care that the Medicare home health benefit covers when someone is homebound and needs intermittent skilled care; home care is the everyday non-medical help that Medicare won't pay for, though low-income Marylanders may cover it through Medicaid.1,2

This guide draws the line between the two and shows how Maryland's two in-home licenses map onto it. Getting the distinction right is how a family avoids paying out of pocket for care a program would have covered, or waiting on Medicare coverage that was never coming.

In This Guide

• Key Takeaways
• Home Care vs. Home Health in Maryland: The Core Difference
• Home Health in Maryland: The Home Health Agency and What Medicare Covers
• Home Care in Maryland: The Residential Service Agency and Who Pays
• Home Care vs. Home Health in Maryland: Which One Do You Need?
• What It Costs
• Frequently Asked Questions

Home Care vs. Home Health in Maryland: The Core Difference

The split is medical versus non-medical, and it settles two things a Maryland family cares about: what the care actually is, and which program pays for it.

Home health is skilled care. A physician orders it because the person has a medical need that requires a licensed professional, a nurse or a physical, occupational, or speech therapist.1 Wound care after surgery, IV medication, injections a patient can't manage alone, therapy to rebuild strength after a stroke or a fall: those are skilled needs. The care is part-time and intermittent, not around-the-clock.

Home care is non-medical help. Most of it is help with the activities of daily living, bathing, dressing, getting to the bathroom, eating, moving around, plus the everyday support that keeps someone safe at home. The person can be medically stable and still need this help every day.

Maryland makes the distinction concrete through its licensing. The OHCQ licenses a Home Health Agency for the skilled, physician-supervised side, and a Residential Service Agency for the broader category that includes non-medical personal care.1 The lines aren't perfectly tidy, an RSA can also provide skilled nursing, but the practical point holds: skilled home health runs through a Home Health Agency that Medicare can certify, and the everyday personal-care help most families are after runs through an RSA.

The same person often needs both. Someone discharged after hip surgery might get home health (a nurse and a physical therapist for a few weeks) and also need personal care (an aide for bathing and meals for months). Those are two different services on two different payment tracks, even when they overlap in the same week.

Home Health in Maryland: The Home Health Agency and What Medicare Covers

A Home Health Agency is the OHCQ-licensed provider for skilled in-home care. It delivers nursing and therapeutic services under a physician's supervision, and to bill Medicare for that care, the agency has to be Medicare-certified.1 The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care the physician ordered.

Medicare's home health benefit covers this care when a beneficiary meets the conditions.1,2 The two that trip families up most:

• Homebound. Leaving home takes considerable, taxing effort, and the person generally needs help or an assistive device to do it. Short, occasional trips out, to a medical appointment or to religious services, don't disqualify someone.
• Intermittent skilled need. A physician certifies that the person needs skilled nursing or therapy on a part-time or intermittent basis, under a plan of care the physician reviews, delivered by a Medicare-certified agency. Under Medicare's rule, "part-time or intermittent" generally means combined skilled nursing and home health aide care of fewer than 8 hours a day and 28 or fewer hours a week (up to 35 on case-by-case review).2

When those conditions are met, Medicare pays for the covered skilled services: the nursing visits, the therapy, medical social services, and the home health aide help attached to that skilled care, and the beneficiary generally pays $0 for those covered services.2 What Medicare home health won't do is staff an aide in the home for general daily help with no skilled-care purpose. That's home care, and it's the next section.

Home Care in Maryland: The Residential Service Agency and Who Pays

In Maryland, the everyday non-medical help most families mean when they say "home care" comes from a Residential Service Agency. An RSA is OHCQ-licensed to provide in-home services that include personal care, help with daily activities and the support around them, and an RSA can also provide skilled nursing.1 RSAs are the state's main licensed providers of private-pay non-medical home care. Because the personal-care piece isn't skilled medical care, the payer picture looks different from home health.

Who pays for personal care comes down to a few routes:

• Private pay. Many families pay out of pocket, by the hour. This is the default when no one qualifies for a public program and the need is non-medical.
• Medicaid in-home personal care. For eligible low-income Marylanders, Medicaid covers in-home personal care through programs such as the Community Options Waiver and Community First Choice, which help people get long-term care at home rather than in a nursing facility.1 Eligibility runs through Maryland Medicaid, so that's where a family starts.
• Long-term care insurance. A private policy, if the person holds one, may reimburse personal-care hours.

One line is worth stating plainly. Medicare does not pay for non-medical personal care.1 A family expecting Medicare to cover an aide for daily help will find it won't, no matter how much that help is needed. The ways to pay for home care are private funds, long-term care insurance, or, for eligible low-income Marylanders, Medicaid.

Home Care vs. Home Health in Maryland: Which One Do You Need?

Start with the need, not the brochure. The table lines up the two provider types across the dimensions that decide what the care is and who pays.1

A quick way to place a situation: if a physician has ordered skilled care and the person is homebound, you're looking at a Home Health Agency, and Medicare is the payer to check first. If the need is ongoing help with everyday tasks and there's no skilled medical component, you're looking at home care from an RSA, and the question becomes whether to pay privately or qualify through Medicaid. Both kinds of care can run at the same time, and plenty of families arrange both at once.

What It Costs

Home health, when Medicare covers it, costs the beneficiary nothing for the covered skilled services.1,2 The cost question really lives on the home-care side, where families pay out of pocket unless Medicaid covers it.

For non-medical home care in Maryland, a non-medical caregiver ran about $80,080 a year per the CareScout 2025 Cost of Care Survey (released March 2026), which works out to roughly $6,673 a month on a basis of 44 hours a week.3 Beginning with its 2025 survey, CareScout merged the former separate homemaker and home health aide categories into a single non-medical caregiver line. Those are industry survey medians, not government rates and not a maximum, so what a specific Maryland agency charges can land above or below them, and the Baltimore and Washington-DC suburbs tend to run higher than rural parts of the state. A family using fewer hours than the full-week assumption will pay less than the annual figure suggests.3

To put the home-care figure in context, here is where it sits against Maryland's other long-term care settings, all CareScout 2025 medians.3

For low-income Marylanders who qualify, that private cost can be covered instead through Medicaid's in-home personal care, the Community Options Waiver or Community First Choice.1 To start, contact Maryland Access Point, the state's aging-and-disability resource center, at 1-844-627-5465; its specialists run a preliminary screen for waiver eligibility and point families to the right application.

Learn More

Find personalized help arranging care at home in Maryland at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.