VA pension is needs-based, so the income VA counts matters as much as the benefit amount. Some medical costs can be subtracted from countable income. That can change the pension figure, but only for costs that are unreimbursed, documented, and tied to health 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.

Why this changes the math

VA measures a household's annual income against a limit it sets each year, and it allows certain expenses to be deducted first. Unreimbursed medical expenses are one of those deductions, and usually only the part above a threshold VA sets can be deducted.1 Check the current threshold on VA.gov rather than relying on anyone's rule of thumb.

What usually counts

  • Premiums the veteran pays for Medicare or other health coverage, when no one reimburses them.
  • Out-of-pocket costs for care a doctor ordered, including copays and deductibles that insurance did not pay.
  • Attendant or in-home care when its purpose is health-related, with records showing the medical need.
  • Reasonable travel to medical care, when the costs are documented.

What usually does not

Groceries, household supplies, general housekeeping, and meals not tied to a medical need generally do not count. Neither does any cost an insurer or another source paid back. A bill that is only partly medical usually needs to be split, and the split needs a written reason.

The proof VA will expect

Keep the invoice or statement, the provider's name, the date paid, the amount, and the insurer's explanation showing nothing was reimbursed. For in-home care, keep the contract or service list showing hours and tasks, a record of payment, and the doctor's documentation of the health need.2 Mileage needs a dated log.

Timing and sorting

Match each expense to the period VA reviews, and do not mix costs from different periods into one total. Sort bills into three piles: clearly medical, clearly not medical, and needs a decision. Take the third pile to a veteran service officer, and use the Local Help: St. Louis Offices page to find one.

This is a briefing on how expense rules work, not financial or legal advice.

1. VA.gov, Veterans pension benefits, income and expense rules.

2. VA.gov, Veterans pension benefits, evidence needed for claimed medical expenses.

Aid and Attendance STL is not affiliated with the U.S. Department of Veterans Affairs.