The Aid and Attendance add-on is paid on top of a VA pension, and the pension has two money tests: a net worth limit and an income limit.1 Most families start by comparing the caregiver's hourly rate with the add-on amount. That comparison skips the step that decides whether there is any add-on to compare. Count the assets first, then the income, then the medical bills that can be subtracted from income, and only then price the care.

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.

Start with net worth

Net worth is the total of what Dad owns that VA counts. That usually means bank and brokerage accounts, cash value in life insurance, and property other than the home he lives in. VA generally does not count the home where the veteran lives, but confirm that rule on the VA pension pages before you rely on it.1 Write each figure on a single sheet with the institution name and a current statement attached, since the application asks for the same values in the same form.2

If the total is over the published limit, the pension is not payable regardless of how high the care bill is. That is the first gate to clear, and it is the cheapest one to check. Do it before anyone signs a caregiver agreement.

Then income, minus the medical bills

VA measures countable income, which is generally annual income reduced by unreimbursed medical expenses above a threshold VA sets.1 This is where in-home care can change the math. Some care costs may be counted as unreimbursed medical expenses, but only when the care is medical in nature and the bills can be documented. Non-medical household help usually does not qualify the same way. Ask the accredited representative which of your invoices, receipts, and provider statements will count, and keep each one in a folder labeled by month of service.3

Do not assume a bill counts because it was paid. Confirm with the representative which costs are accepted and what paperwork VA expects for each.

What to check before you call anyone

  • The published net worth limit and the figure you calculated, side by side.
  • Each asset line, with the statement that supports it.
  • Dad's annual income from every source, including any sums that arrive in the form of a check.
  • Every medical bill for the past year, sorted into bills that are clearly medical and bills that are household or companionship costs.
  • Whether the representative will review the worksheet before it goes to VA, and what they charge, if anything.

How caregiver tasks affect the price

The price of in-home care is set by the hours, the tasks, and the caregiver's qualifications. A hired non-medical caregiver can give medication reminders and pick up prescriptions as an errand. Sorting, dispensing, or managing medicine stays with the family, the doctor, and the pharmacist. Write that split into the agreement, because the task list also decides which bills can later be documented as medical.

What it costs: The Missouri median for non-medical in-home care is $33 an hour, per the CareScout (Genworth) Cost of Care Survey 2025 state data tables, released March 2026. New Plan Care's standard rate is $34 an hour with a four-hour minimum, so a visit starts at $136 (newplancare.com/services).

If a provider offers a single hourly rate with no line for overnight or minimum-hour charges, ask for those terms in writing before Dad's care starts. The pension will not change the agreement's terms, so the gap has to be planned against the full bill.

Private pay while the claim is pending

Care can begin on private pay while the claim is pending. If VA approves the claim, the add-on may be paid back to the effective date that VA assigns, and that date depends on when the claim was received or when an intent to file was recorded.4 Do not budget the back payment as certain money. Budget the monthly gap as the amount Dad pays until approval arrives, and treat any retroactive payment as a bonus.

Where to get the worksheet checked for free

The net worth and income worksheets are the part of the claim most often done wrong, and they are the part an accredited representative can review without charge through a county or state service office or a national veterans organization. The Local Help: St. Louis Offices page lists where to start. For the list of published sources this guide relies on, see Sources.

Medicaid is a separate test

Medicaid is not a VA program. Its asset and income rules differ from the VA pension rules, so a figure that passes one test may fail the other. Do not treat the VA worksheet as a Medicaid screen. Ask the Medicaid agency or a qualified adviser to review that question on its own terms.

Footnotes

  1. VA pension program and eligibility, https://www.va.gov/pension/
  2. VA pension application, VA Form 21P-527EZ, listed on Find VA Forms, https://www.va.gov/find-forms/
  3. VA accreditation of claims representatives, https://www.va.gov/ogc/
  4. Intent to File, VA Form 21-0966, listed on Find VA Forms, https://www.va.gov/find-forms/