What specific medical expenses are deductible from countable income for VA means tests in 2025?
Executive summary
For VA means tests in 2025, deductible medical expenses are the out‑of‑pocket, non‑reimbursed costs that VA allows to be subtracted from countable income — examples include payments for doctors, dentists, prescriptions, Medicare and other health insurance premiums, hospital and nursing‑home care, and transportation for medical purposes (including mileage at the GSA POV rate) [1] [2]. VA guidance and its publications (Form 10‑10EZR, the Medical Expense Report form, and the IB reference guide) enumerate many specific categories and require that expenses were paid and not reimbursed [1] [3] [4].
1. What the rulebook says — the regulatory backbone
VA’s regulation defining “deductible medical expenses” for needs‑based programs is in 38 C.F.R. §3.278; it explicitly treats transportation for medical purposes (mileage, parking, tolls) as a deductible medical expense and ties the mileage rate to the current GSA privately owned vehicle (POV) reimbursement rate [2]. That regulation is the legal standard VA applies when deciding which items may reduce countable income for pension/means assessments [2].
2. What VA’s forms and guidance list — practical categories you can submit
VA’s application and reporting forms instruct veterans to report “total non‑reimbursed medical expenses” paid by the veteran or spouse, and give concrete examples: doctors, dentists, medications, Medicare, health insurance, hospital, nursing home, eyeglasses, and other health care expenses for household members you legally or morally support [1]. The Medical Expense Report (VA Form 21P‑8416) lists prescription and non‑prescription drug costs, transportation to medical care, and other examples while warning not to include reimbursed items [3].
3. How VA treats reimbursement and documentation — evidence matters
VA repeatedly emphasizes non‑reimbursed status: do not include expenses you were or will be reimbursed for, and if reimbursement arrives after filing you must notify VA [3]. The Information Bulletin and verification guidance note that VA may require documentation and that case managers will help identify deductible items — VA can and will verify expenses when they affect eligibility for free care or medications [4] [5].
4. Thresholds and calculation context — not every dollar reduces countable income
VA guidance and the IB reference material explain that deductible medical expenses are subject to calculation rules: VA computes a deductible and the “net” medical expenses you may claim; examples in the IB show partial deductions (e.g., a portion of paid medical expenses may be applied against income) [4] [1]. VA’s public pages and forms frame medical deductions as a way to lower countable income to meet national thresholds for free care or medication eligibility [5] [6].
5. Common examples cited by VA and third‑party guides
Across VA forms and the IB, recurring examples include: doctor and dental fees, prescription drugs, Medicare and insurance premiums, hospital and nursing‑home fees, eyeglasses, home health services, and transportation expenses [1] [3] [4]. Outside analysts and benefit guides reiterate that these categories align with 38 C.F.R. §3.278’s standard for medically necessary costs that prevent or slow functional decline [7] [2].
6. Areas where sources diverge or are silent — watch for nuance
VA’s official materials focus on “non‑reimbursed” and give illustrative lists [1] [3], while the IB and outside summaries explain calculation mechanics and thresholds but do not publish a single exhaustive list of every allowable item [4] [7]. Available sources do not mention a complete, binding checklist of every permissible or impermissible expense for 2025; instead VA relies on the regulatory text and adjudicatory guidance to decide edge cases [2] [4]. Claimants should expect case‑by‑case review and to supply supporting evidence [3] [4].
7. Practical advice and next steps — what veterans should do now
Collect and save receipts for out‑of‑pocket, non‑reimbursed medical spending (prescriptions, premiums, travel, doctor/hospital bills), complete VA Form 10‑10EZR and, if needed, the VA Form 21P‑8416 medical expense report when asked, and be prepared to show proof because VA will verify items that affect eligibility [1] [3] [8]. If you’re unsure whether a particular item qualifies, the IB and forms instruct you to provide a full description and VA will determine deductibility under 38 C.F.R. §3.278 [4] [2].
Limitations: this summary uses only VA regulatory text, VA forms, the IB reference guide, and related VA pages included in the provided search results; available sources do not provide an exhaustive, line‑by‑line list of every deductible item for 2025 and note that VA adjudicators apply the rules to specific facts [2] [4].