VA Form 21P-8416

Medical Expense Report

PensionOfficial VA form on VA.gov

Who fills it

veteran

Journey phase

Keeping Your Award Current

Estimated time

30-45 minutes with receipts gathered.

When to file

Annually with your pension income report, or whenever your medical expenses change significantly. Can also be filed with the initial 21P-527EZ.

You are a pension recipient with significant out-of-pocket medical costs, or you are applying for pension and want to deduct eligible medical expenses.

Gather before you start

—Receipts or statements for all out-of-pocket medical expenses

—Medicare premium amounts (Part A, B, D)

—Medigap or supplemental insurance premiums

—Prescription copays and out-of-pocket drug costs

—Physician, hospital, dental, vision copays

—Home health aide or in-home care costs (paid caregiver receipts)

—Assisted living or nursing home fees (if not fully covered by insurance)

—Medical equipment, prosthetics, hearing aids

—Transportation costs for medical appointments (mileage)

Attach with the form

—Receipts for all reported expenses (recommended; VA may request verification)

—Insurance premium statements

—In-home care contracts or payment records

Section I - Claimant Identification

1 field

Blocks 1-3Name, SSN, VA File NumberPII

Match your pension award file. Include the VA File Number from your pension award letter so this report attaches to the correct award.

Example

(legal name, SSN, VA pension file number)

Common mistakes

Omitting VA File Number - report cannot be matched to your pension file.

Section II - Insurance Premiums

1 field · 1 citation

Blocks 4-10Monthly and annual health insurance premiums paid out-of-pocket

Report premiums you pay for: Medicare Part B (typically $174.70/mo in 2024), Medicare Part D, Medigap/supplemental plans, any other health or prescription insurance. Do NOT include premiums deducted from Social Security before you receive it - only report what comes out of your own pocket AFTER the SSA deduction.

Example

e.g., Medicare Part B: $174.70/mo; Medigap Plan F: $220/mo; Part D: $35/mo = $429.70/mo total premiums

Common mistakes

Reporting the gross Medicare Part B premium when it is deducted from SSA - only the amount you pay separately counts.
Forgetting a supplemental dental or vision insurance premium - these count if out of pocket.

Authority

38 CFR 3.3 - Eligibility criteria for veterans pension: wartime service, discharge character, income below MAPR, and net worth below threshold.

Section III - Prescription and Medication Costs

1 field

Blocks 11-14Out-of-pocket prescription costs after insurance

Copays, deductibles, and non-covered drugs you pay. Include: prescription copays at the pharmacy, the Part D coverage gap ("donut hole") costs, non-covered medications, over-the-counter drugs prescribed by a physician.

Example

e.g., 4 monthly prescriptions at $8 copay = $32/mo; insulin $45/mo = $77/mo total

Common mistakes

Not tracking copays monthly - small copays add up to significant annual deductions.
Forgetting Part D coverage gap costs if you reach it.

Section IV - Home Care, Facility Care, Transportation

1 field · 2 citations

Blocks 15-22In-home aide costs, assisted living fees, medical transportationRepeatable

These are often the largest deductible expenses: (1) Paid home health aides or personal care attendants - hourly or monthly cost; (2) Adult day care center fees; (3) Assisted living monthly fees not covered by insurance; (4) Medical transportation (mileage to/from appointments at VA standard rate); (5) Medical equipment not covered (CPAP supplies, wheelchair maintenance). Keep contracts and receipts.

Example

e.g., Home aide 20 hrs/week at $15/hr = $1,200/mo; Medical mileage 80 mi/mo x $0.21 = $16.80/mo

Common mistakes

Not claiming in-home care costs because the caregiver is a family member - family members paid for care can be reported as medical expenses with proper documentation.
Forgetting that the costs must be expected to continue for 12 months to fully count - one-time expenses may be prorated.

Authority

38 CFR 3.3 - Eligibility criteria for veterans pension: wartime service, discharge character, income below MAPR, and net worth below threshold.

M21-1 V.iv.3 - Calculating IVAP for pension eligibility.

Section V - Certification

1 field

Blocks 23-24Claimant signature and datePII

Sign and date certifying all reported expenses are accurate and unreimbursed.

Example

(signature/date)

Common mistakes

Claiming reimbursed expenses - only amounts you actually paid out-of-pocket count.

Statutory & regulatory authority

38 CFR 3.3 - Eligibility criteria for veterans pension: wartime service, discharge character, income below MAPR, and net worth below threshold.

M21-1 V.iv.3 - Calculating IVAP for pension eligibility.

VA Form 21P-8416

Medical Expense Report

PensionOfficial VA form on VA.gov

Who fills it

veteran

Journey phase

Keeping Your Award Current

Estimated time

30-45 minutes with receipts gathered.

When to file

Annually with your pension income report, or whenever your medical expenses change significantly. Can also be filed with the initial 21P-527EZ.

You are a pension recipient with significant out-of-pocket medical costs, or you are applying for pension and want to deduct eligible medical expenses.

Gather before you start

—Receipts or statements for all out-of-pocket medical expenses

—Medicare premium amounts (Part A, B, D)

—Medigap or supplemental insurance premiums

—Prescription copays and out-of-pocket drug costs

—Physician, hospital, dental, vision copays

—Home health aide or in-home care costs (paid caregiver receipts)

—Assisted living or nursing home fees (if not fully covered by insurance)

—Medical equipment, prosthetics, hearing aids

—Transportation costs for medical appointments (mileage)

Attach with the form

—Receipts for all reported expenses (recommended; VA may request verification)

—Insurance premium statements

—In-home care contracts or payment records

Section I - Claimant Identification

1 field

Blocks 1-3Name, SSN, VA File NumberPII

Match your pension award file. Include the VA File Number from your pension award letter so this report attaches to the correct award.

Example

(legal name, SSN, VA pension file number)

Common mistakes

Omitting VA File Number - report cannot be matched to your pension file.

Section II - Insurance Premiums

1 field · 1 citation

Blocks 4-10Monthly and annual health insurance premiums paid out-of-pocket

Example

e.g., Medicare Part B: $174.70/mo; Medigap Plan F: $220/mo; Part D: $35/mo = $429.70/mo total premiums

Common mistakes

Reporting the gross Medicare Part B premium when it is deducted from SSA - only the amount you pay separately counts.
Forgetting a supplemental dental or vision insurance premium - these count if out of pocket.

Authority

38 CFR 3.3 - Eligibility criteria for veterans pension: wartime service, discharge character, income below MAPR, and net worth below threshold.

Section III - Prescription and Medication Costs

1 field

Blocks 11-14Out-of-pocket prescription costs after insurance

Example

e.g., 4 monthly prescriptions at $8 copay = $32/mo; insulin $45/mo = $77/mo total

Common mistakes

Not tracking copays monthly - small copays add up to significant annual deductions.
Forgetting Part D coverage gap costs if you reach it.

Section IV - Home Care, Facility Care, Transportation

1 field · 2 citations

Blocks 15-22In-home aide costs, assisted living fees, medical transportationRepeatable

Example

e.g., Home aide 20 hrs/week at $15/hr = $1,200/mo; Medical mileage 80 mi/mo x $0.21 = $16.80/mo

Common mistakes

Not claiming in-home care costs because the caregiver is a family member - family members paid for care can be reported as medical expenses with proper documentation.
Forgetting that the costs must be expected to continue for 12 months to fully count - one-time expenses may be prorated.

Authority

38 CFR 3.3 - Eligibility criteria for veterans pension: wartime service, discharge character, income below MAPR, and net worth below threshold.

M21-1 V.iv.3 - Calculating IVAP for pension eligibility.

Section V - Certification

1 field

Blocks 23-24Claimant signature and datePII

Sign and date certifying all reported expenses are accurate and unreimbursed.

Example

(signature/date)

Common mistakes

Claiming reimbursed expenses - only amounts you actually paid out-of-pocket count.

Statutory & regulatory authority

38 CFR 3.3 - Eligibility criteria for veterans pension: wartime service, discharge character, income below MAPR, and net worth below threshold.

M21-1 V.iv.3 - Calculating IVAP for pension eligibility.

VA Form 21P-8416

Medical Expense Report

PensionOfficial VA form on VA.gov

Who fills it

veteran

Journey phase

Keeping Your Award Current

Estimated time

30-45 minutes with receipts gathered.

When to file

Annually with your pension income report, or whenever your medical expenses change significantly. Can also be filed with the initial 21P-527EZ.

You are a pension recipient with significant out-of-pocket medical costs, or you are applying for pension and want to deduct eligible medical expenses.

Gather before you start

—Receipts or statements for all out-of-pocket medical expenses

—Medicare premium amounts (Part A, B, D)

—Medigap or supplemental insurance premiums

—Prescription copays and out-of-pocket drug costs

—Physician, hospital, dental, vision copays

—Home health aide or in-home care costs (paid caregiver receipts)

—Assisted living or nursing home fees (if not fully covered by insurance)

—Medical equipment, prosthetics, hearing aids

—Transportation costs for medical appointments (mileage)

Attach with the form

—Receipts for all reported expenses (recommended; VA may request verification)

—Insurance premium statements

—In-home care contracts or payment records

Section I - Claimant Identification

1 field

Blocks 1-3Name, SSN, VA File NumberPII

Match your pension award file. Include the VA File Number from your pension award letter so this report attaches to the correct award.

Example

(legal name, SSN, VA pension file number)

Common mistakes

Omitting VA File Number - report cannot be matched to your pension file.

Section II - Insurance Premiums

1 field · 1 citation

Blocks 4-10Monthly and annual health insurance premiums paid out-of-pocket

Example

e.g., Medicare Part B: $174.70/mo; Medigap Plan F: $220/mo; Part D: $35/mo = $429.70/mo total premiums

Common mistakes

Reporting the gross Medicare Part B premium when it is deducted from SSA - only the amount you pay separately counts.
Forgetting a supplemental dental or vision insurance premium - these count if out of pocket.

Authority

38 CFR 3.3 - Eligibility criteria for veterans pension: wartime service, discharge character, income below MAPR, and net worth below threshold.

Section III - Prescription and Medication Costs

1 field

Blocks 11-14Out-of-pocket prescription costs after insurance

Example

e.g., 4 monthly prescriptions at $8 copay = $32/mo; insulin $45/mo = $77/mo total

Common mistakes

Not tracking copays monthly - small copays add up to significant annual deductions.
Forgetting Part D coverage gap costs if you reach it.

Section IV - Home Care, Facility Care, Transportation

1 field · 2 citations

Blocks 15-22In-home aide costs, assisted living fees, medical transportationRepeatable

Example

e.g., Home aide 20 hrs/week at $15/hr = $1,200/mo; Medical mileage 80 mi/mo x $0.21 = $16.80/mo

Common mistakes

Not claiming in-home care costs because the caregiver is a family member - family members paid for care can be reported as medical expenses with proper documentation.
Forgetting that the costs must be expected to continue for 12 months to fully count - one-time expenses may be prorated.

Authority

38 CFR 3.3 - Eligibility criteria for veterans pension: wartime service, discharge character, income below MAPR, and net worth below threshold.

M21-1 V.iv.3 - Calculating IVAP for pension eligibility.

Section V - Certification

1 field

Blocks 23-24Claimant signature and datePII

Sign and date certifying all reported expenses are accurate and unreimbursed.

Example

(signature/date)

Common mistakes

Claiming reimbursed expenses - only amounts you actually paid out-of-pocket count.

Statutory & regulatory authority

38 CFR 3.3 - Eligibility criteria for veterans pension: wartime service, discharge character, income below MAPR, and net worth below threshold.

M21-1 V.iv.3 - Calculating IVAP for pension eligibility.

VA Form 21P-8416

Medical Expense Report

PensionOfficial VA form on VA.gov

Who fills it

veteran

Journey phase

Keeping Your Award Current

Estimated time

30-45 minutes with receipts gathered.

When to file

Annually with your pension income report, or whenever your medical expenses change significantly. Can also be filed with the initial 21P-527EZ.

You are a pension recipient with significant out-of-pocket medical costs, or you are applying for pension and want to deduct eligible medical expenses.

Gather before you start

—Receipts or statements for all out-of-pocket medical expenses

—Medicare premium amounts (Part A, B, D)

—Medigap or supplemental insurance premiums

—Prescription copays and out-of-pocket drug costs

—Physician, hospital, dental, vision copays

—Home health aide or in-home care costs (paid caregiver receipts)

—Assisted living or nursing home fees (if not fully covered by insurance)

—Medical equipment, prosthetics, hearing aids

—Transportation costs for medical appointments (mileage)

Attach with the form

—Receipts for all reported expenses (recommended; VA may request verification)

—Insurance premium statements

—In-home care contracts or payment records

Section I - Claimant Identification

1 field

Blocks 1-3Name, SSN, VA File NumberPII

Match your pension award file. Include the VA File Number from your pension award letter so this report attaches to the correct award.

Example

(legal name, SSN, VA pension file number)

Common mistakes

Omitting VA File Number - report cannot be matched to your pension file.

Section II - Insurance Premiums

1 field · 1 citation

Blocks 4-10Monthly and annual health insurance premiums paid out-of-pocket

Example

e.g., Medicare Part B: $174.70/mo; Medigap Plan F: $220/mo; Part D: $35/mo = $429.70/mo total premiums

Common mistakes

Reporting the gross Medicare Part B premium when it is deducted from SSA - only the amount you pay separately counts.
Forgetting a supplemental dental or vision insurance premium - these count if out of pocket.

Authority

38 CFR 3.3 - Eligibility criteria for veterans pension: wartime service, discharge character, income below MAPR, and net worth below threshold.

Section III - Prescription and Medication Costs

1 field

Blocks 11-14Out-of-pocket prescription costs after insurance

Example

e.g., 4 monthly prescriptions at $8 copay = $32/mo; insulin $45/mo = $77/mo total

Common mistakes

Not tracking copays monthly - small copays add up to significant annual deductions.
Forgetting Part D coverage gap costs if you reach it.

Section IV - Home Care, Facility Care, Transportation

1 field · 2 citations

Blocks 15-22In-home aide costs, assisted living fees, medical transportationRepeatable

Example

e.g., Home aide 20 hrs/week at $15/hr = $1,200/mo; Medical mileage 80 mi/mo x $0.21 = $16.80/mo

Common mistakes

Not claiming in-home care costs because the caregiver is a family member - family members paid for care can be reported as medical expenses with proper documentation.
Forgetting that the costs must be expected to continue for 12 months to fully count - one-time expenses may be prorated.

Authority

38 CFR 3.3 - Eligibility criteria for veterans pension: wartime service, discharge character, income below MAPR, and net worth below threshold.

M21-1 V.iv.3 - Calculating IVAP for pension eligibility.

Section V - Certification

1 field

Blocks 23-24Claimant signature and datePII

Sign and date certifying all reported expenses are accurate and unreimbursed.

Example

(signature/date)

Common mistakes

Claiming reimbursed expenses - only amounts you actually paid out-of-pocket count.

Statutory & regulatory authority

38 CFR 3.3 - Eligibility criteria for veterans pension: wartime service, discharge character, income below MAPR, and net worth below threshold.

M21-1 V.iv.3 - Calculating IVAP for pension eligibility.