Ask What Counts as a Medical Expense Before the First Invoice Arrives

When a VA pension is figured, certain out-of-pocket medical costs can be deducted from countable income. That makes an aide's bill look like it might lower the number, and some of it may. Not every line on a care invoice qualifies, and the difference between a personal care charge and a housekeeping or companion charge matters. Ask before the first invoice arrives, not after the claim is filed.¹

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

Ask the provider for line items

Ask whether the invoice will list personal care hours separately from homemaker, errand, and companion hours. Ask whether the provider issues receipts that show the veteran's name, the dates of service, the type of service, and the amount paid. A bill that lumps every hour together gives a claim reviewer nothing to sort.

Ask whether the premium counts

Health insurance premiums and certain copays are often handled differently from an aide's hourly fee. Ask the VA-accredited representative or the service officer which costs have been accepted in claims like yours, and ask them to name the rule they are relying on. Get that answer in writing if you can.

Keep the expense ledger apart from the shift log

Expenses and care shifts are two records. Keep the expense ledger as its own file, with each receipt, premium notice, and copay statement filed by month. That lets you total what was paid without rereading every shift record. A receipt is not proof of care hours by itself, so keep the provider's service record alongside it.

Questions to ask before you sign

Before you agree to a rate, ask whether the invoice separates personal care from other services, whether the provider issues itemized monthly statements, and whether you will receive a copy of every invoice. Those answers decide whether the expense ledger is easy to build or a pile of paper later.²

This briefing does not give tax or legal advice. Ask a qualified tax preparer or a VA-accredited representative about your specific return or claim. For free filing help in St. Louis, see Local Help: St. Louis Offices. The source list is on Sources.

Notes
1. VA.gov, pension benefits pages: unreimbursed medical expenses can be considered in the income calculation for a pension claim.
2. VA.gov, pension benefits pages: a pension claim is needs based, so documented expenses support the income calculation.