If A Spouse Is Ill But A Veteran Isn’t, Can A Couple Still Get VA benefits for Long-Term Care Expenses?
While the veteran is alive, the claim is the veteran’s. In cases where the Veteran is over 65 and healthy, but the Veteran’s Spouse is ill, the best that the couple can qualify for is the base pension amount. If the Veteran is healthy, but the spouse is not, the couple will not qualify for Aid & Attendance benefits. However, if the Veteran dies the surviving spouse would be eligible to apply for the additional Aid & Attendance benefit.
When determining which level of benefit that would be awarded, whether an improved pension, housebound or aid and attendance, the VA will look at the health of the Veteran alone. The health of the Spouse does not matter. Assuming a Veteran over 65, the Veteran meets the VA’s initial definition of disabled. This places the Veteran at the base pension level. Unless the Veteran has more medical issues, there is no eligibility for housebound or aid and attendance. Again while the Veteran is alive, the health of the Spouse does not matter at this point.
But once the initial level is determined and eligibility is established based on the health of the Veteran, the fact that the Spouse resides in an assisted living, or is receiving home health care that depletes the couples combined monthly income, is relevant for the income eligibility test. In 2018 a Veteran and Spouse can receive $1,436.75/ month in Veteran’s Benefits at the base pension level. If the Veteran and Spouse’s combined income exceeds this amount, they do not qualify unless their medical expenses outweigh their income.
It is at this point that the Spouse’s assisted living or home health care expenses become relevant because the expenses are used in making the income eligibility determination. In order for those expenses to be an approved medical expense, the spouse needs to be examined by a doctor and a form 21-2680 must be filled out and turned in along with the application. While the form 21-2680 is entitled “Examination For Housebound Status Or Permanent Need For Regular Aid And Attendance” and is primarily used to establish housebound or aid and attendance if filled out for the veteran, it is used to help verify the spouse’s costs as a valid medical expense, not turn in a housebound or assisted living claim for the spouse.
Once the medical expense is established, the medical costs can then be offset from the Veteran and Spouse’s joint income in order to try to meet the income eligibility test.