You may be able to pay for long term care services through VA, Federal and State programs (Medicare and Medicaid), and through insurance or your private funds. Click on the tabs in this section of the Guide for more information about these sources of funding.
Your eligibility for long term care services, provided in any long term care setting, will be determined based on your need for ongoing treatment, personal care, and assistance, as well as the availability of the service in your location. Other factors, such as financial eligibility, your service-connected (VA disability) status, insurance coverage, and/or ability to pay may also apply.
If you still have questions after reading this section of the Guide to Long Term Care, call toll-free, 1-877-222-VETS (8387), Monday through Friday, 7 a.m. to 7 p.m. (CST). Or, contact your VA social worker.
Veterans must be enrolled in VA health care before applying for VA long term care services. Enrolled in VA health care means you have applied for VA health care benefits, and receive care through a VA facility on a regular basis. Receiving financial compensation for a VA disability does NOT automatically enroll you in VA health care.
You may be eligible for VA health care services (known as the Standard Medical Benefits Package) if you served in the military and were discharged for any reason other than dishonorable.
Detailed eligibility information can be found on the main VA Health Benefits website.
When you enroll in VA health care, your (1) VA service-connected disability status and (2) income will be reviewed to determine whether or not you are charged a copay for VA health care services and VA long term care services. Long term care copays are different from standard VA health care copays because they are not charged until the 22nd day of care. Copays are NOT charged for Hospice Care provided in any setting.
The VA is required by law to bill any other health insurance you may have (except Medicare) for treatment of conditions that are not service-connected. Payments received from your insurance company will reduce the copays that VA bills to you.
Home and Community Based Services are part of the VA Medical Benefits Package. All enrolled Veterans are eligible for these services. However, to get the service you must have a clinical need for it, and the service must be available in your location. Services in the VA Standard Benefits Package include:
Some Home and Community Based Services may be prioritized based on your level of VA service-connected disability.
Nursing Home and Residential Settings have different eligibility requirements for each setting. The VA does not pay for room and board in residential settings such as Assisted Living or Adult Family Homes. However, you may receive some Home and Community Based Services while you are living in a residential setting.
The VA will provide Community Living Center (VA Nursing Home) or community nursing home care IF you meet certain eligibility criteria involving your service connected status, level of disability, and income.
A “service-connected disability” is a disability that is related to your active military service. Your disability is assigned a rating (0% to 100%) based on how severely it impacts your daily life. The greater your disability, the higher your rating.
VA Disability Compensation is a monthly tax-free payment to Veterans who have a service-connected disability. The higher your rating, the higher monthly payments will be.
However, having a disability caused by your active military service does NOT automatically start disability compensation payments. You need to APPLY for those benefits. It is important to do this because your service-connected disability status has an effect on how much you pay for VA health care services, what programs you are eligible for, and your priority in receiving certain services.
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There are several ways to apply for your service-connected disability status. You can:
Your disability needs to be reviewed by staff at VBA and assigned a rating before you can receive payments.
If you receive VA compensation for a service-connected disability, you may be eligible to receive additional monthly monetary benefits if you ALSO:
You can use your Special Monthly Compensation payments to help pay for services that you need.
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Veterans Pension is a tax-free monetary benefit paid to low-income war-time Veterans who are ALSO:
Low-income guidelines are set by Congress. A single Veteran, with no dependents, must have an annual income of less than $12,465 to be considered low-income in 2013. Additional income is allowed if you have dependents. A chart of income limits can be found on the Maximum Annual Pension Rate website.
Your payments will raise your income to the Maximum Annual Pension Rate, and not exceed it. For example, if you are a single Veteran who earns $10,000 per year, then your monthly payment would be about $205 ($12,465 maximum annual pension rate - $10,000 current annual income, divided by 12 months). Pension benefits are paid monthly.
If you receive a VA pension, you may be eligible to receive additional monthly monetary benefits from the VA, IF you:
You can use your Aid and Attendance payments to help pay for the services that you need.
If you receive a VA pension, you may be eligible to receive additional monthly monetary benefits from the VA, IF you are significantly restricted to your residence because of a permanent disability. You can use your Housebound Allowance payments to help pay for the services that you need.
Send a written statement to your Veterans Benefits Administration regional office that includes a report from your doctor that describes your need for these benefits. The report should include:
Medicare is the federal health insurance system for people:
You can enroll in “Original Medicare” or a “Medicare Advantage Plan.”
Once you enroll, you receive services from any organization or provider that accepts Medicare as long as the services are ordered by your doctor, approved by Medicare as being medically necessary, and covered by your plan.
Once you select a plan and enroll, you receive services from any organization or provider that accepts your plan’s coverage as payment as long as the services are approved by your plan as being medically necessary and covered by your plan.
There are 3 components, or “parts,” of Original Medicare services:
If you enroll in Part A, you can also enroll in Parts B and D. Here is a summary of the long term care services provided in each of these parts:
These plans provide coverage for the same services as hospital insurance (Part A) and medical coverage (Part B) of the Original Medicare plan. Most of these plans also include prescription drug coverage (Part D). Here are the most common types of Medicare Advantage Plans. Review the different plans to find one that best fits your needs.
Many people are automatically enrolled in Medicare benefits (Part A and B) because they are already receiving Social Security benefits or Railroad Retirement Board benefits. In this case, Part A and Part B enrollment starts the first day of the month you turn 65.
If you are under 65 and disabled, Part A and Part B enrollment starts after you receive disability benefits from Social Security or certain RRB disability benefits for 24 months.
If you are enrolled automatically you will receive a red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability benefits if under 65 years old. Instructions will be included with your card to decline Part B coverage if you do not want it.
Some people who are eligible are not automatically enrolled and need to sign up for Part A and Part B benefits. Most often these are people who are 65 or older but not receiving Social Security or Railroad Retirement Board benefits.
To sign up for benefits:
Original Medicare will pay for services in a Skilled Nursing Facility and some home health services. Medicare Advantage Plans are required to provide the same benefits, however, they may charge different copays and/or change the eligibility standards.
You can receive care in a skilled nursing facility for a limited number of days (Original Medicare helps pay costs for up to 100 days in a benefit period) if your doctor decides that you require skilled care after a hospital stay. The facility must be certified by Medicare. Skilled care means services are provided by skilled nursing or rehabilitation staff, such as a nurse or physical therapist.
Your Skilled Nursing Facility Costs under Original Medicare
If you selected a Medicare Advantage Plan, your costs will vary based on that specific plan.
If your doctor decides that you are home-bound (your condition keeps you from leaving home without significant effort), then you may be eligible for home health services under hospital insurance (Part A) and medical coverage (Part B). Covered services may include (but are not limited to):
Services must be ordered by a physician and provided by a Medicare-certified home health agency for Original Medicare enrollees. Medicare Advantage Plan members must use a home health agency that accepts their plan’s payment.
Custodial care is help with personal care needs such as dressing or bathing. If the ONLY type of care you need is custodial, then Medicare will not pay for your care in a nursing home or in your own home. Medicare may cover medical and rehabilitation services provided in an Assisted Living Facility, but typically will not cover the costs of the facility – such as rent and meals.
Medicaid is the joint federal/state insurance program that helps people with low incomes pay for their medical costs. This may include help with Medicare premiums, copays, and deductibles. Medicaid can also pay for some services not covered by Medicare.
Specific eligibility criteria will vary by state. The information provided is a general guide to eligibility. Speak with your VA social worker or state Medicaid office to determine your eligibility.
To apply for Medicaid benefits in any state you need to:
The application can be found at your local state Medicaid office. Many states also provide Medicaid applications at aging/disability assistance agencies throughout the community.
You must meet the requirements of all three eligibility categories listed below to qualify for Medicaid coverage of long term care services: General, Functional, and Financial.
Medicaid covers Nursing Home services for all eligible people age 21 and older. Medicaid will also cover Home and Community Based Services for eligible people IF they would need to be in a Nursing Home without those services. Covered Home and Community Based Services vary by state. For example, some states cover Assisted Living Facility costs, while other states do not. Many states cover services to help you remain in your home, such as help with personal care needs or some chores (laundry, cleaning). Specific services should be discussed with your state Medicaid office or your social worker.
Based on your income, you may be eligible for Medicaid coverage of some portion of your Medicare premiums/copays. Your state may also require you to pay for some of your Medicaid covered services, if you have enough income to do so. This varies by state. Talk with staff in your state Medicaid office to find out how this works in your state.
Private Pay: Even though VA, Medicare, Medicaid and other funding sources cover the costs of some long term care services and settings, many people need to use their own income or savings to pay part of the costs for long term care services or settings they need or prefer.
For example, people often use their own resources to pay for:
Long Term Care Insurance can also be used to pay for long term care services and settings. Since long term care policies vary, do your homework and choose wisely.
If you already live in a Nursing Home or Assisted Living Facility, or you already need help with activities of daily living such as bathing, dressing, or using the toilet, then you probably will not qualify for a long term care policy.
Veterans Crisis Line:
1-800-273-8255 (Press 1)
U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420
Last updated July 10, 2014