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VA’s Aid and Attendance Benefits Can Cover Long-Term Care Costs for Veterans

Qualifying veterans can receive up to $2,727 each month to help pay for care

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The crushing cost of long-term care can quickly deplete your retirement savings. It’s one of Medicare’s big gaps: Medicare does not pay for long-term care in a nursing home or assisted living facility and it provides very limited coverage for home care.

But many veterans are eligible for a valuable benefit to help with these expenses. The Department of Veterans Affairs’ Aid and Attendance program can pay as much as $2,727 per month in 2024, with benefits that can continue for the rest of their lifetime.

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“There are likely many veterans out there that are unaware they are potentially eligible for Aid and Attendance benefits,” says Keith Wilson, director, Benefits Center of Excellence for the Virginia Department of Veterans Services. “It’s a huge challenge trying to reach these veterans.”

Some veterans may have served decades ago and haven’t worked with the VA since then. But if they served at least one day during wartime and need help with activities of daily living, such as bathing, dressing and eating, it’s worthwhile to see if they are eligible. They must meet income requirements, but their cost of long-term care — including nursing home, assisted living and home care costs — can help reduce their income in the calculations and make it easier to qualify.

Beth Agnello’s dad, Les, served in the Navy during World War II, attended college on the GI Bill, and then spent more than 40 years teaching physics and physical education in Richmond, California. He and his wife, Gene, moved to a retirement community when they were in their mid-80s.

Les started showing signs of cognitive impairment, and after Gene had a stroke in April 2010, they both needed extra help and moved to an assisted living facility. Suddenly, their living expenses exploded — topping $4,000 per month. The facility’s director knew that Les was a WWII veteran and told Beth that he was likely to qualify for the VA’s Aid and Attendance benefit to help cover the cost of care.

Beth went to a local Veterans Service Organization office for help — VSOs are organizations that assist veterans with VA claims — and ended up working with an expert from the American Legion who knew how to navigate the complicated application process. Gene died in December 2010, but Les remained in assisted living. After mounds of forms and several long letters to and from the VA, Les started to receive Aid and Attendance benefits about six months later. It paid more than $1,600 per month for 10 years, until he died in February 2020 at age 98.

Between his teacher’s pension and his Aid and Attendance benefits, he was able to cover the cost of care — first in California, then when he moved to a more expensive facility in North Carolina to be near Beth — without having to deplete his small nest egg. He had enough money left over that he could attend minor league baseball games of his beloved Winston-Salem Dash with her until the year before he died.

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Beth Agnello and her dad, Les.
Courtesy Beth Agnello

Many wartime veterans need help with the activities of daily living as they get older but are unaware of benefits they are eligible for or are intimidated by the time-consuming application process. These benefits can be incredibly valuable, providing a monthly payout for as long as the veteran or surviving spouse needs care. The average age of veterans receiving Aid and Attendance benefits is currently about 74, says Kevin Friel, deputy director, pension and fiduciary services for the VA’s Veterans Benefits Administration.

How much can I receive in VA long-term care benefits?

In 2024, veterans with one dependent (usually a spouse) who need care can receive up to $2,727 per month in Aid and Attendance benefits (more than $32,000 per year), or up to $2,300 per month without a dependent, depending on their income and cost of care.

Surviving spouses of eligible veterans without dependents can receive up to $1,479 per month if they need care after the veteran dies.

The money is paid monthly as a supplement to the veteran’s pension. You must need help with at least two activities of daily living to qualify, but you don’t need to spend the money specifically to reimburse the cost of long-term care. However, paying for long-term care — in a nursing home, assisted living facility or in your own home — can help make you eligible for benefits.

Who qualifies for Aid and Attendance benefits?

Veterans who are at least 65 years old or have a permanent and total disability can receive Aid and Attendance benefits if they meet specific service, asset, income and medical requirements.

Service requirements: Veterans who started active duty before Sept. 8, 1980, must have served on active duty for at least 90 days, with at least one day during wartime. Some veterans who started after Sept. 7, 1980 must have served up to 24 months, including at least one day during wartime. (The requirements for Vietnam War era veterans were recently expanded as a result of the PACT Act.)

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Wartime periods:

  • WWII: Dec. 7, 1941, to Dec. 31, 1946
  • Korean conflict: June 27, 1950, to Jan. 31, 1955
  • Vietnam War era for veterans who served in the Republic of Vietnam: Nov. 1, 1955 to May 7, 1975
  • Vietnam War era for veterans who served outside the Republic of Vietnam: Aug. 5, 1964, to May 7, 1975
  • Gulf War: Aug. 2, 1990, until the present

For a list of full requirements see the VA’s Eligibility for Veterans Pension. The veteran doesn’t need to have retired from the military but can’t have a dishonorable discharge.

Asset requirements: The VA changed the asset calculation a few years ago to make it easier to apply for benefits. In 2024, a veteran (and spouse, if married) must have less than $155,356 in assets, including bank accounts, investment accounts, IRAs, other retirement accounts, and the cash value of life insurance. The calculation does not include the veteran’s primary residence or car. This asset level is adjusted for the cost of living each year.

Income requirements: The income criteria is complicated, but paying for medical expenses and long-term care can make it easier to qualify.

Income can include Social Security benefits, any pension payments and other forms of income. But you can subtract the cost of eligible medical expenses, including long-term care costs, when calculating adjusted income. The annual income limit is the same as the maximum benefit amount: $27,609 to receive Aid and Attendance benefits in 2024 for veterans without dependents; $32,729 for veterans with dependents.

The countable income then reduces the maximum pension benefit you can receive. For example, a veteran with $12,000 income and no unreimbursed medical expenses could receive $15,609 in Aid and Attendance benefits in 2024, which is paid in monthly payments of $1,300.75, says Wilson.

Veterans who have large long-term care costs can receive more. For example, if a veteran pays $30,000 in nursing home costs, their countable income becomes $0 and they can receive the full $27,609 in annual Aid and Attendance benefits, which is paid in monthly payments of $2,300.75, says Wilson.

Medical requirements: The service, income and asset requirements are the same as they are for the veterans pension. But in order to receive the higher Aid and Attendance benefits, you must meet extra medical requirements. A doctor typically must certify that you need help with activities of daily living such as bathing, eating and getting dressed. Nursing home patients need to provide extra paperwork from the facility about the costs and type of care they receive.

Surviving spouses who need care may be eligible, too. The survivor must have been married to the veteran for at least one year prior to his or her death. Surviving spouses with dependents can receive up to $21,166 in Aid and Attendance benefits in 2024, or up to $17,743 with no dependents.

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Other housebound benefits for veterans

Housebound benefits: Veterans who meet the requirements for the veteran pension program but don’t need help with activities of daily living may be able to receive housebound benefits if they need help leaving their home to go to doctor’s appointments, shopping or for other needs. “They may be able to take care of their daily needs and feed themselves, but they can’t leave the house,” says Wilson.

Housebound benefits in 2024 can be worth up to $1,685 per month for veterans without a dependent, and $2,112 with a dependent.

Disability compensation Aid and Attendance: Someone who is receiving disability compensation and needs help with activities of daily living specifically for that service-related condition can receive extra benefits, called Special Monthly Compensation (SMC).

These benefits have different service, asset and income requirements compared to Aid and Attendance benefits. However, to qualify, they must meet disability compensation requirements and have certain medical conditions or need daily help with basic needs, such as eating, dressing and bathing.

How to apply for veteran long-term care benefits

Any veteran who needs long-term care and has at least one day of wartime service should look into whether they’re eligible for this benefit, says Friel. Family members who are helping veterans or their surviving spouses can help.

You can apply for Aid and Attendance at the same time as applying for veterans pension benefits, if you are not receiving it already. Even if your income had been too high in the past, you may be now be eligible if you’ve accumulated a lot of medical and long-term care expenses.

How to apply for Aid and Attendance or Housebound benefits

  • Complete VA form 21-2680.
  • Provide a doctor’s report or other evidence showing that you need help with at least two activities of daily living or help with housebound care.
  • Additional forms are required if you’re in a nursing home.

Free assistance with the application process

The application process can be daunting. “There is nothing about the process that is seamless,” says Beth Agnello, who has an MBA and is now a financial planner. “But help is out there; don’t give up.”

You can get free help from a Veterans Service Organization. “A VSO is the best resource,” says Friel. “They are trusted partners, we coordinate with them and help with their training.” You can find a VSO in your area that provides free assistance here, which is how Beth found the expert from the American Legion.

Matthew Jahn, associate national service director for the Disabled American Veterans (DAV), another VSO, says you can grant power of attorney to any accredited VSO so they can request the documents from the VA.

The power of attorney can help gather federal records, such as the DD-214 and VA medical records. They may also contact a veteran’s private doctor and request medical records, but Wilson says that step is usually faster if the family contacts them instead.

You can meet with a VSO representative in person or virtually. The DAV, for example, has offices in 62 VA facilities across the country. “They can come in person, make an appointment, or do the initial meeting via phone and everything can be done remotely,” says Jahn. “With the digital age, it improves our reach to assist those in more rural locations.”

Each state also has a department of veterans services that serve as VSOs and has staff that can help with applications. The Virginia Department of Veterans Services, for example, has 36 offices at VA facilities, military medical centers and many military bases throughout Virginia.

“They can sit down with our employee, who can fill out their forms for them,” says Wilson. “We have all those forms in our system, and they can sign it while they’re in the office and electronically send them to the VA and go directly into the VA’s system.” They can also meet by Zoom and Teams.

“A lot of veterans haven’t dealt with the VA much before and they may assume they have to go to an attorney for these benefits and pay for that, but that absolutely is not the case,” says Wilson.

Some estate planning attorneys do help with Aid and Attendance applications, but unlike with VSOs, there are situations where they may charge for their services. You can find an accredited attorney representative or VSO and find out more about their services here.

Why timing is important

Wilson recommends that the veteran or their family members contact the VSO as soon as they think the veteran may be eligible for the benefit, even before they’ve gathered the documents.

Completing the intent to file form is important. You have up to one year after submitting the intent to file document to gather the paperwork and complete the application, but the benefits may be paid retroactively to the intent to file date if eligible. “When the veteran becomes eligible, the effective date of that award starts on the date of that intent to file,” says Wilson.

It takes several months for the VA to process the application, and the more information you can provide up front, the better. “If everything goes well, we can get it done in three to four months or so, but if we need to go out and gather more information, it will take longer,” says Friel.

You may be able to file an expedited application in special situations to speed up the process, such as being homeless, in severe financial hardship or having a terminal condition. “When we talk with the veteran or their family, we can get an idea of the urgency of their claim — if they’re already in financial hardship or poor health, there’s a form we can complete for the VA that requests expedited processing of the claim,” says Wilson. “In those types of situations, the VA can turn around the claim in 60 days or so.”

Beware of salespeople who claim they’ll help you qualify for Aid and Attendance benefits if you purchase high-commission products. The VA added a three-year look-back period in October 2018, so any money you give away or use to buy certain trusts or financial products within that time period can delay your eligibility for benefits.

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