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Care and Coverage Guide
Care and Coverage Guide for Families
Your comprehensive guide to understanding home health services, Medicare coverage, and how to get the care you need at home. Let's explore your options together.
What would you like to learn about?
Coverage Guide
Understand what Medicare covers for home care
- Home health coverage and cost sharing depend on Medicare eligibility and current program rules
- Durable medical equipment can have separate deductible and coinsurance rules
- Eligibility depends on Medicare homebound, skilled-need, and provider-order rules
Am I Eligible?
Review common Medicare home health criteria
- Medicare Part A or Part B coverage
- Homebound status (difficulty leaving home)
- Order from a doctor or other allowed provider for home health care
- Need for skilled nursing or therapy
Physical Therapy
Outpatient & in-home rehabilitation
- Direct access available; plan rules vary
- Clinic visits or in-home sessions
- Balance, mobility, and strength training
- Post-surgery rehabilitation
Home Health Services
Skilled nursing & therapy at home
- CHAP-accredited skilled nursing
- Wound care & medication management
- Physical, occupational & speech therapy
- May be covered by Medicare for eligible patients
Companion Care
Non-medical support & assistance
- Meal preparation & light housekeeping
- Appointment-related planning or errands when available; ask whether transportation can be provided
- Non-medical reminders when available; companions do not administer medication
- Meaningful companionship
Understanding Your Coverage Options
Medicare and insurance coverage can be complex. Here's what you need to know about your options:
Medicare Coverage
Government Insurance
Part A and Part B: Medicare covers certain home health services when eligibility requirements are met
Covered services: Original Medicare generally has no copay for covered home health services when eligibility and coverage rules are met. Other costs can apply, and durable medical equipment has separate cost-sharing rules.
Private Insurance
Varies by Plan
Coverage varies significantly by plan and provider
Coverage questions reviewed with you
Our team can help you review coverage questions and next steps.
Private Pay
Rates Confirmed
Pay directly when an appropriate self-pay option is available
Review Common Medicare Home Health Criteria
Use this educational checklist to understand common starting requirements.
This checklist does not determine coverage or acceptance by VIGEO. A provider order, clinical review, service-area confirmation, Medicare requirements, and agency availability still apply.
0 of 4 criteria met
Have questions about the starting criteria? Our team can review the next step, but Medicare or your plan determines coverage.
Call (703) 244-6884 to Review OptionsYou checked the four basic starting criteria.
A provider order, clinical review, coverage review, service-area confirmation, and agency availability are still required before care can begin.
Ready to Get Started?
Our local Northern Virginia team is here to help you navigate your options and get the care you need.
Medicare-Certified Home Health
Home Health Services
Skilled nursing and therapy delivered in the comfort of your home. Medicare may cover eligible home health services ordered by a doctor or other allowed provider with no copay for covered care; durable medical equipment may have coinsurance.
What would you like to learn about?
Medicare Coverage
Part A & Part B benefits explained
- Part A and Part B: Medicare covers certain home health services when eligibility requirements are met
- Original Medicare generally has no copay for covered home health services
- Durable medical equipment has separate deductible and coinsurance rules
What Is Home Health?
Skilled nursing & therapy at home
- Skilled nursing care (wound care, IV therapy, injections)
- Physical, occupational & speech therapy
- Part-time or intermittent home health aide care, only while the person is also receiving a qualifying skilled service
- Medical social services
Getting Started
Begin your home health journey
- Order from a doctor or other allowed provider required for home health
- Provider-order and face-to-face requirements are reviewed before care begins
- Start timing depends on the provider order, eligibility, clinical needs, and availability
- A care plan is developed after the initial assessment
How Care Is Organized
Steps vary by order, needs, and availability
- An initial assessment is scheduled after the referral is accepted and start timing is confirmed
- The care plan, visit schedule, and any needed supplies are coordinated
- Visits follow the approved plan of care
- The plan is reviewed as required or when needs change
Medicare Coverage for Home Health
Eligibility Requirements
Eligibility BasedYou Qualify If:
- You are homebound (difficulty leaving home)
- A doctor or other allowed provider orders care and reviews the plan
- Care is intermittent (not 24/7)
- Face-to-face visit with a doctor or allowed provider within 90 days before or 30 days after care starts
- Using Medicare-certified agency (like VIGEO)
Covered Services
Eligibility RequiredMedicare May Cover:
- Skilled nursing and home health aide care are generally part-time or intermittent and commonly limited to 28 hours per week combined, with limited exceptions when additional care is medically necessary; aide care requires a qualifying skilled service at the same time
- Physical therapy services
- Occupational therapy services
- Speech-language pathology
- Medical social services
- Medical supplies (wound dressings, etc.)
Medicare Part A and Part B
Eligibility BasedCoverage Details:
- Part A and Part B: Medicare covers certain home health services when eligibility requirements are met
- Original Medicare generally has no copay for covered home health services when eligibility and coverage rules are met
- Durable medical equipment has separate deductible and coinsurance rules
- A doctor or allowed provider must order care and review the plan of care
- Plan recertified every 60 days
Important: Homebound Status
Medicare considers you homebound if leaving home requires considerable effort or assistance. You can still leave for medical appointments, religious services, or adult day care without affecting your eligibility. Occasional trips for special events (family gatherings, funerals) or personal care (barber/salon) are also allowed.
What Is Home Health Care?
Home Health Explained
What it is: Skilled medical care delivered in your home by licensed professionals, ordered by a doctor or other allowed provider and provided by a Medicare-certified Home Health Agency. Services include nursing, physical therapy, occupational therapy, and speech therapy.
What it isn't: 24/7 care, housekeeping, or personal care services like bathing and dressing when that's the only need. Home health focuses on medical recovery and skilled care.
Cost: Original Medicare generally has no copay for covered home health services when eligibility and coverage rules are met. Other costs can apply, and durable medical equipment has separate cost-sharing rules.
Starting Your Home Health Journey
Getting Started Checklist
- From Hospital/SNF: Ask discharge planner for Medicare-certified agencies or choose VIGEO directly
- From Home: Ask your doctor or other allowed provider about a referral and face-to-face visit requirements
- Confirm you meet homebound requirements (difficulty leaving home without help)
- Get your complete medication list and any recent test results ready
- Prepare questions about your care needs and schedule preferences
- Have your Medicare card and insurance information available
How Home Health Care Begins
1
Initial Assessment
After a referral is accepted, the team confirms the start date based on the provider order, eligibility, clinical needs, and availability. The initial assessment reviews your needs and supports coordination with your provider.
2
Care Plan and Schedule
The team develops a plan of care and visit schedule based on your assessment, provider order, and confirmed coverage. Timing varies by situation.
3
Ongoing Care
Visits follow the approved plan of care. The plan is reviewed as required and when needs change; family members may be taught appropriate care techniques.
Making Your Home Safe
Fall Prevention
- Remove loose rugs and clear walkways
- Add nightlights in hallways and bathrooms
- Install grab bars and handrails where needed
- Keep frequently used items within easy reach
Medication Safety
- Keep an updated list of all medications
- Ask a pharmacist or clinician whether a pill organizer is appropriate
- Store medications safely away from heat and moisture
- Know how to properly dispose of unused medications
Emergency Preparedness
- Post important phone numbers by the phone
- Have a flashlight and batteries accessible
- Keep a list of current medications by the bed
- Know your agency's after-hours or emergency contact process, if one is provided
Your Rights as a Patient
Know Your Care Plan
You have the right to understand your treatment plan, participate in planning your care, and consent to or refuse any treatment.
Appeal Decisions
If covered services are ending, the written notice will explain appeal rights and deadlines. Follow that notice or contact Medicare for current instructions.
File Complaints
You can file complaints about your care through Medicare's complaint system or contact the Medicare Beneficiary Ombudsman for help.
Privacy Protection
Your health information is protected by HIPAA. The agency can share information with family members involved in your care if you agree.
Questions about Home Health?
Share the basic situation. Our team will review service area, provider-order, eligibility, and coverage questions before explaining the next step.
Expert Rehabilitation Services
Physical Therapy Services
Outpatient and in-home physical therapy focused on strength, mobility, and independence goals. Care setting and availability are confirmed before scheduling.
What would you like to learn about?
Payment & Coverage
Medicare, insurance & payment options
- Medicare Part B: Coverage depends on medical necessity, plan rules, and benefit details
- Many private plans may be accepted; confirm plan-specific coverage
- Self-pay options available
- Virginia direct-access rules may allow evaluation without a referral; some plans still require one
Understanding PT
What physical therapy can do for you
- Treatment may help address pain and movement goals
- Exercises and education can support movement and function
- Balance work may help reduce fall risk
- An individual treatment plan is based on your evaluation
Our Programs
Specialized therapy for your needs
- Post-surgical rehabilitation
- Balance & fall prevention
- Orthopedic & sports injuries
- Chronic pain management
Your First Visit
What to expect at your evaluation
- Evaluation length depends on your needs and care setting
- Review of medical history & goals
- Physical assessment & testing
- Personalized treatment plan created
Payment & Coverage Options
Medicare Part B
Cost Sharing VariesMedicare Part B Coverage:
- If Medicare covers outpatient therapy, deductible and coinsurance may apply
- Coverage depends on medical necessity and current Medicare rules
- Ask us and your plan to confirm benefits before treatment
Private Insurance
Varies by PlanTypical Coverage:
- Visit limits vary by plan
- Coverage, copays, and visit limits vary by plan
- Contact us to confirm your benefits
- Our team can help you review coverage questions and next steps
Private Pay
Flexible OptionsSelf-Pay Options:
- Ask whether an appropriate self-pay option is available
- Request current rates before scheduling
- Visit frequency depends on your plan, goals, scheduling, and availability
Understanding Physical Therapy
What Is Physical Therapy?
Physical therapy is a healthcare service that can support movement, strength, function, and recovery goals after injury, surgery, or illness. Your therapist develops a plan based on your evaluation, needs, and care setting.
When you might need it: After surgery, injury, or if you're experiencing pain, balance issues, or difficulty with daily activities like walking, climbing stairs, or getting in and out of chairs.
What to Expect at Your First Visit
1
Initial Evaluation
Your therapist will review your medical history, assess your current condition, test your strength, range of motion, and balance. You'll discuss your goals and concerns together.
2
Treatment Plan Development
Based on your evaluation, your therapist creates a personalized treatment plan with specific goals, expected timeline, and recommended visit frequency for your situation.
3
Regular Treatment Sessions
Each session may include targeted exercises, manual therapy, education, and possibly equipment use. Session length and frequency are adjusted to your plan and progress.
Common Questions Families Ask
How long will therapy take?
Progress and total treatment time vary based on your condition, goals, visit frequency, and how well you follow your home exercise program.
Will it hurt?
You may experience some discomfort while working on strength and mobility. Tell your therapist about severe, increasing, or unexpected pain so the plan can be adjusted and appropriate next steps discussed.
Do I need a referral?
A referral may not be required in some situations under Virginia rules; some insurance plans still require one. Ask VIGEO and your plan what applies before scheduling.
Will I have homework?
Your therapist may recommend exercises between visits based on your plan. Ask how often to do them and what symptoms should prompt you to stop or call.
Can family members come to appointments?
Family members may participate when appropriate. They can learn how to support the plan and understand safety precautions for home.
What should I wear?
Comfortable, loose-fitting clothes that allow easy movement. Athletic wear is ideal. Avoid jewelry that might interfere with treatment. Wear comfortable athletic shoes.
How Physical Therapy Helps
Pain Management
- May help address pain as part of your overall medical plan
- Looks at movement and activity factors that may contribute to symptoms
- Can include techniques for managing symptoms during daily activities
Improved Function
- Helps you return to activities you enjoy
- May support goals for daily tasks and independence
- Can address work activities and ways to lower injury risk
Fall Prevention
- May build balance, strength, and coordination
- Identifies and addresses fall risk factors
- Increases confidence in movement and mobility
Specialized Therapy Programs
Orthopedic Rehabilitation
- Joint replacement recovery
- Post-surgical rehabilitation
- Fracture & sports injury care
- Arthritis management
Neurological Therapy
- Stroke rehabilitation
- Parkinson's & MS management
- Brain injury recovery
- Spinal cord injuries
Balance & Vestibular
- Fall prevention programs
- Dizziness & vertigo treatment
- Gait & balance training
- Vestibular rehabilitation
Pain Management
- Chronic pain treatment
- Manual therapy techniques
- Therapeutic exercises
- Modality treatments
Benefits of Physical Therapy
Improved Mobility
Restore range of motion, strength, and functional movement patterns for daily activities.
Pain Reduction
Treatment may help address pain and activity goals as part of your overall medical plan.
Fall Prevention
Balance training and strength exercises may support fall-risk reduction and movement confidence.
Recovery Support
A treatment plan can support recovery goals after surgery, injury, or illness. Results and timing vary.
Independence
Work toward goals for daily tasks and independence at home.
Conditioning Goals
Build a plan around appropriate fitness, activity tolerance, and long-term movement goals.
Questions about Physical Therapy?
Share your movement concern and preferred care setting. We will review referral, coverage, and availability questions before discussing next steps.
Compassionate Daily Support
Companion Care Services
Non-medical support services to maintain independence and quality of life at home. Current rates, scheduling rules, and service details are reviewed before care begins.
What would you like to learn about?
What Is Companion Care?
Understanding non-medical support
- Companionship & conversation
- Light housekeeping & meal prep
- Appointment-related planning or errands when available; ask whether transportation can be provided
- Non-medical reminders when available; companions do not administer medication
Our Services
Common companion support options
- Companionship & conversation
- Errands & grocery shopping
- Meal preparation & light household help
- Contact us to confirm available support
Pricing & Payment
Current rates and scheduling details
- Current rates are confirmed during intake
- Scheduling rules are reviewed before care begins
- Ask your insurer or benefits administrator whether your plan may reimburse companion care
- Confirm any required approval or documentation directly with that administrator; VIGEO does not determine benefit eligibility
Benefits
How companion care may support routines and social connection
- Opportunities for companionship and conversation
- Support for daily routines at home
- Scheduled companion visits when available
- Additional routine support for family caregivers
Payment Options
VIGEO Companion Care is generally a private-pay service. Current rates, scheduling rules, and any fees are reviewed before care begins.
- Call for current rates
- Scheduling requirements are confirmed during intake
- Fee and contract details are reviewed before services begin
Additional Payment Support: Please inquire with our team about other payment options that may be available to help support your companion care needs. Call us at (703) 244-6884 to discuss your specific situation.
What Is Companion Care?
Companion Care Explained
What it is: Non-medical companion support that may include help with daily routines and social needs - companionship, errands, meal preparation, light household help, organizing, conversation, and reminders. Contact us to confirm available support for your situation.
What it isn't: Skilled medical care like nursing or therapy. If hands-on personal care or clinical tasks are needed, VIGEO will help identify the appropriate service.
Best for: Those seeking social interaction, help with errands, or light assistance at home who do not require skilled medical care or continuous supervision.
When Companion Care Might Be Right for You
Social Support
Your loved one needs extra social interaction, emotional support, or someone to keep them company during the day.
Light Daily Tasks
Daily needs like meal preparation or light housekeeping are becoming difficult, and skilled medical care or continuous supervision is not required.
Family Support
Family caregivers want scheduled companion support for daily routines. Scope and availability are confirmed during intake.
Companion Care Services
Personal Companionship
- Friendly conversation & social interaction
- Reading & recreational activities
- Hobby assistance & encouragement
- Emotional support & understanding
Household Support
- Light housekeeping & tidying
- Laundry & linen changes
- Meal preparation & planning
- Grocery shopping assistance
Errands & Outings
- Errands & grocery shopping
- Appointment-related planning
- Social outings when available
- Contact us to confirm available support
Reminders & Routine
- Non-medical reminders when available; companions do not administer medication
- Daily-routine support
- Encouragement to follow family routines
- Care needs reviewed before services begin
Daily Routine Support
- Companionship during daily routines
- Meal preparation reminders
- Light household help
- Contact us to confirm available support
Family Support
- Companion visits to reduce isolation
- Routine updates for family caregivers
- Scheduling questions reviewed during intake
- Care scope confirmed before services begin
Benefits of Companion Care
Companionship
Scheduled visits can provide conversation, shared activities, and social connection.
Daily Routine Support
Available services may support selected daily routines at home.
Scheduled Presence
Companion care is not emergency response or continuous supervision. Call 911 for urgent medical help.
Routine Encouragement
Companions may offer non-medical reminders and encouragement within the support plan; they do not administer medication.
Family Support
Scheduled visits may help families share some routine support. Services and availability are confirmed during intake.
Rate and Schedule Options
Ask about current rates, scheduling, and which available non-medical services fit your situation.
Is Companion Care Right for You?
Check the items that apply to your situation:
These examples are conversation starters, not a care assessment. Tell us what support would help and our team will confirm scope and availability.
Questions about Companion Care?
Tell us what daily-routine support would help. We review non-emergency requests during business hours and confirm services, rates, scheduling, and care boundaries. Call 911 for urgent medical help.