End of Life Planning Checklist for Maryland: Every Step You Need to Take

End-of-Life Planning in Maryland Has More Steps Than Most States

Maryland is one of only a handful of states that imposes both an estate tax and an inheritance tax. The estate tax exemption is frozen at $5 million — less than half the federal exemption of $15 million. The inheritance tax hits non-lineal heirs (unmarried partners, nieces, nephews, cousins, friends) at a flat 10% on any assets they receive. These overlapping systems mean that end-of-life planning in Maryland requires coordinating medical, legal, and financial documents more carefully than in most other states.

Here is the complete checklist.

Medical Planning

1. Complete your advance directive. Fill out the statutory Maryland advance directive form, which includes both healthcare agent designation (Part I) and treatment preferences/living will (Part II). Use physical initials — not checkmarks — for your treatment selections.

2. Execute the document with proper witnesses. Two adult witnesses must watch you sign. Your healthcare agent cannot be a witness. At least one witness must be a non-inheriting party.

3. Add a dementia supplement if relevant. If you or a family member has early-stage cognitive decline, add supplemental instructions addressing treatment preferences at early, middle, and late stages of dementia. The standard form only addresses sudden, catastrophic medical events.

4. Complete a MOLST with your physician. Schedule an appointment with your primary care physician to discuss and sign a Medical Orders for Life-Sustaining Treatment form. EMS cannot honor your advance directive in the field — they follow the MOLST.

5. Carry identification. Obtain a medical wallet card or Medic Alert bracelet/necklace indicating you have advance directives and a MOLST on file.

6. Distribute copies. Give copies of your advance directive to your healthcare agent, your physician, your hospital, and upload to MyDirectives.com.

Legal Planning

7. Execute a last will and testament. Name a personal representative (executor) to manage your probate estate. If you have minor children, designate a guardian.

8. Execute a financial power of attorney. Unlike the advance directive, Maryland's financial power of attorney requires notarization and two adult witnesses. This document lets your agent manage finances if you become incapacitated.

9. Consider a standby guardianship. If you are a single parent or if both parents could become incapacitated simultaneously, a standby guardianship designates someone to care for your minor children immediately, without court delay.

Financial Planning

10. Assess your probate exposure. Maryland classifies estates under $50,000 (or $100,000 if a surviving spouse is the sole heir) as "small estates" — these bypass formal probate with minimal fees. Estates above this threshold face graduated probate fees from $100 up to $10,000+.

11. Set up non-probate transfers. Assets that bypass probate also bypass Maryland's Medicaid estate recovery program, which by state law can only reach your probate estate. Consider:

• Beneficiary designations on bank accounts, retirement accounts, and life insurance
• Transfer-on-Death (TOD) registration for vehicles through the MVA
• Life estate deeds or joint tenancy for real property

12. Plan for the inheritance tax. If any portion of your estate will pass to non-lineal heirs, the 10% inheritance tax applies to the clear value of those assets. Strategic annual gifting using the federal $19,000 gift tax exclusion can reduce this exposure over time.

13. Plan for the estate tax. If your estate exceeds $5 million, Maryland's estate tax applies with rates ranging from 0.8% to 16%. Unlike the federal exemption, Maryland's threshold is not indexed for inflation. Married couples should understand Maryland's portability rules for the deceased spouse's unused exclusion.

14. Address the augmented estate. Since October 2020, a surviving spouse can claim an elective share of the "augmented estate," which includes both probate and non-probate assets. If you have a blended family, consider a marital agreement to coordinate these provisions.

The Connection Between Healthcare and Financial Planning

In Maryland, these tracks are not independent. If you enter long-term care funded by Medicaid, the state can seek recovery against your probate estate after death. Structuring assets to pass outside probate protects them from this recovery. Completing your advance directive without addressing probate avoidance leaves a financial gap that can cost your family tens of thousands of dollars.

The Maryland Advance Directive & Living Will Kit coordinates both tracks — healthcare directives and financial planning worksheets — in a single system designed around Maryland's specific statutory requirements.

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