Veterans Benefits & Aid and Attendance for Long-Term Care

One of the most underutilized benefits available to aging veterans and their surviving spouses is the VA Aid and Attendance (A&A) pension — a benefit that can provide over $2,000 per month to help pay for assisted living, home health aides, or nursing home care. Unlike Medicaid, A&A has no transfer penalty or lookback period (though the VA has implemented a 36-month lookback for asset transfers since October 2018). For veterans and surviving spouses who need care but don't qualify for Medicaid — or who need help bridging the gap until Medicaid kicks in — A&A can be transformative.

Who Qualifies?

The Aid and Attendance pension is available to wartime veterans (or their surviving spouses) who meet the following criteria:

• Military service: At least 90 days of active duty, with at least one day during a qualifying wartime period (WWII, Korea, Vietnam, Gulf War/post-9/11). The veteran does not need to have served in a combat zone — just during a wartime period.
• Discharge: Other than dishonorable.
• Medical need: The claimant requires the regular aid and attendance of another person to perform activities of daily living (bathing, dressing, eating, toileting), or is bedridden, or is in a nursing home, or has corrected visual acuity of 5/200 or less in both eyes.
• Income: Unreimbursed medical expenses (including assisted living or home care costs) must reduce countable income below the Maximum Annual Pension Rate (MAPR). For a single veteran with A&A in 2025, the MAPR is approximately $29,000. For a surviving spouse, approximately $15,000.
• Assets: Net worth (excluding the primary residence and personal property) must not exceed approximately $155,356 (adjusted annually for inflation).

2025–2026 Maximum Monthly Rates (Approximate)

Category	Monthly Rate
Veteran with Aid & Attendance (no dependents)	~$2,431
Veteran with spouse, with A&A	~$2,879
Surviving spouse with A&A	~$1,563
Veteran — housebound (no A&A)	~$1,803

Rates are adjusted annually. These are tax-free benefits.

The 36-Month Lookback (Since October 2018)

Before 2018, the VA pension had no asset transfer restrictions. That changed with the implementation of a 36-month lookback period for asset transfers. If the claimant (or their spouse) transferred assets for less than fair market value within the 36 months preceding the application, the VA will impose a penalty period during which the pension benefit is reduced or denied.

This is shorter than Medicaid's 5-year lookback but still requires advance planning. The penalty calculation divides the transferred amount by the MAPR to determine the number of penalty months.

How A&A Fits with Medicaid Planning

A&A and Medicaid are not mutually exclusive — they serve different populations and can work together:

• Before Medicaid: Many families use A&A to help pay for assisted living or home care during the years before Medicaid eligibility. Medicaid doesn't cover most assisted living — A&A can fill that gap.
• During the lookback: If the family made asset transfers and is within the 5-year Medicaid lookback, A&A can help pay for care during the penalty period.
• Instead of Medicaid: For veterans whose income or assets are slightly too high for Medicaid but who can't afford care privately, A&A may be the only available benefit.