Families planning for VA nursing home or respite care often ask what it will cost. VA’s answer depends on the type of care and the veteran’s finances, reported on one form.
Here are the 2026 rules.
2026 extended care copay maximums
| Care | Daily maximum |
|---|---|
| Nursing home care (Community Living Center) | $97 |
| Overnight (institutional) respite | $97 |
| Overnight geriatric evaluation | $97 |
| Adult day health care | $15 |
| Daytime (non-institutional) respite | $15 |
| Geriatric evaluation without overnight stay | $15 |
| Domiciliary care | $5 |
Source: 38 CFR 17.1111; VA copay rates effective January 1, 20262.
There’s no copay for the first 21 days of extended care in a 12-month period, counted from the date VA first provided extended care1. VA counts each day of adult day care or daytime respite, and each full or partial inpatient day except the discharge day1.
How VA figures your copay
The amounts above are maximums. The actual copay depends on the level of care and the veteran’s available resources, figured monthly from the financial information on VA Form 10-10EC, Application for Extended Care Services21.
If a spouse still lives at home and isn’t receiving extended care, VA’s 2026 community spouse resource allowance of $162,660 reduces the liquid assets counted2.
Who pays no copay
VA’s rule lists those not subject to extended care copays1, including:
- A compensable service-connected disability. Any rating that pays compensation.
- Income below the basic pension rate, $17,441 for a single veteran in 20263.
- Care for a 0% service-connected condition. Care for that condition only.
- Medal of Honor recipients. No extended care copays.
- Catastrophically disabled veterans, for adult day care, daytime respite and outpatient geriatric evaluation.
- Certain exposure-related care under VA's special authorities.
Care bought from community providers
For extended care through the Veterans Community Care Program, there’s no copay at the time of service; VA bills afterward, and never more than the VA rate1.
Other VA health care copays
Outside long-term care, 2026 copays include $15 for primary care and $50 for specialty care for veterans without a 10% or higher service-connected rating, and medication copays capped at $700 a year2. Hospice has no copay4. See VA pharmacy benefits.
Worked example: a single veteran in a VA nursing home
VA’s rule sets the copay at the lower of the daily maximum or what the veteran can actually pay from available resources, figured month by month1. During the first 180 days of extended care, available resources are the income of the veteran and spouse, minus a veteran allowance of $20 a day, a spousal allowance of $20 a day if the spouse lives in the community, and basic living expenses1.
| Step | Amount |
|---|---|
| Monthly income (Social Security and a small pension) | $2,400 |
| Minus veteran allowance ($20 x 30 days) | -$600 |
| Minus basic expenses (none, no home kept) | $0 |
| Available resources | $1,800 |
| Maximum copay ($97 x 30 days) | $2,910 |
| Copay owed that month | $1,800 |
Illustrative figures, not a quote. VA computes the real amount from VA Form 10-10EC.
Source: Formula and allowances from 38 CFR 17.111(d)1; 2026 daily maximum from VA copay rates2.
After 180 days of extended care, VA also counts liquid and fixed assets, not just income, minus the allowances and, if a spouse is protected, a spousal resource protection amount1. That’s why the first months and later months can produce very different bills.
What VA counts as income, assets and expenses
- Income: wages, Social Security, pensions, VA payments, interest, dividends, annuity income, cash gifts and inheritances1.
- Liquid assets: cash, stocks, bonds, mutual funds, IRAs, 401(k)s and annuities, and collectibles; household and personal items count only when no spouse or dependent lives at home1.
- Expenses: basic living costs such as rent or mortgage on the main home, one car payment, food, utilities and insurance, and court-ordered payments1.
- Spouse at home: the spousal resource protection amount equals the Medicaid community spouse resource maximum, which VA lists as $162,660 for 202621.
- Separated spouses: when legally separated, the spouse's income, assets and expenses aren't counted1.
How to apply and keep the copay right
- Ask the VA social worker for VA Form 10-10EC, Application for Extended Care Services, when care is first requested6.
- Attach proof of income, assets and expenses for both spouses: benefit letters, bank and brokerage statements, rent or mortgage and insurance bills.
- File again after any break in extended care longer than 30 days, and each year when you update your health care financial information1.
- Report changes within 10 days, such as a death, divorce, a sold asset or a new expense1.
- Ask for a review if the bill looks wrong; the copay can be reduced or eliminated when you document lower resources1.
Common mistakes
- Not filing 10-10EC at all. Without it VA can't reduce the charge below the daily maximum1.
- Forgetting the spouse at home. The $20 spousal allowance and the resource protection amount apply only if VA knows a spouse lives in the community1.
- Assuming a service-connected rating doesn't matter. Any compensable rating removes extended care copays entirely1.
- Confusing these with Medicare costs. Medicare's skilled nursing coinsurance is a separate program: $217 a day for days 21 to 100 in 20267.
How copays interact with other benefits
Pension with Aid and Attendance counts as income on 10-10EC like any VA payment1. A veteran in a Medicaid-covered nursing home who gets pension is limited to $90 a month8, which is a separate rule from VA’s own extended care copay. Medication copays are separate too, capped at $700 in 20262.