Does long-term care insurance or a VA pension pay for rides? Other ways families cover transportation

What a long-term care policy pays for

Long-term care insurance pays for care services, and rides are not among the standard ones. The NAIC’s consumer guide, which most states require insurers or agents to hand buyers, lists the services a policy may cover:

• Nursing home care
• Home care and personal care at home
• Respite care
• Hospice care
• Services in assisted living facilities
• Services in adult day care centers
• Services in other community facilities

Transportation is not on that list. Two policy features matter if you hope an aide will also handle appointments:

• Homemaker or chore services. Some policies, though not all, pay for someone to come to the home to cook meals and run errands. Adding home care benefits generally raises the premium.
• Who may provide home care. Some policies pay only for licensed providers or agencies. Others pay home care aides who are not licensed or not from an agency. A policy with the broader rule gives a family more choice of aide.

Neither feature promises that an aide’s time in a waiting room is covered. Read the policy’s list of covered services and its definitions, and ask the insurer in writing before you count on it.

Benefits start only after two hurdles

A policy pays nothing until your parent meets its benefit triggers. The most common one is being expected to be unable to do two of six daily activities without another person’s help for 90 days: bathing, continence, dressing, eating, toileting, and transferring. Policies differ on whether that help must be hands-on or can be someone standing by. The other is a cognitive impairment, such as Alzheimer’s disease. Tax-qualified policies cannot use a doctor’s statement of medical necessity as a trigger.

Then comes the elimination period, a waiting period chosen at purchase, commonly 20 to 100 days, during which the family pays for care. Most policies do not pay family members who provide care, and some do not count that family care toward the waiting period. Check the exclusions and definitions before relying on a relative’s help to get through it.

Cash benefits can pay for rides; reimbursement benefits cannot

How a policy pays matters more for rides than what it lists. The NAIC describes three methods:

• Expense-incurred. The policy pays the lesser of the actual expense or the policy’s dollar limit, for covered services only. Most policies sold today pay this way, and a ride bill does not fit.
• Indemnity. The policy pays a set dollar amount directly to the policyholder, regardless of what the care cost.
• Disability. The policy pays the full daily benefit whether or not your parent receives long-term care services that day.

Under the last two methods, the payment reaches the family as money, and the family decides how to spend it, rides included. Life insurance policies with long-term care riders can also pay either a reimbursement or a set monthly amount. Look in the policy and its outline of coverage for the section on eligibility for benefits and the one on how benefits are paid.

Medigap does not help with rides either. It pays some or all of your parent’s share for services Original Medicare covers, such as the 20 percent coinsurance on an ambulance trip Medicare approves, depending on the plan letter, and it has no ride benefit of its own. The programs that do pay for rides, including Medicaid, PACE, and some Medicare Advantage plans, are in our guide to free rides to medical appointments for seniors.

VA pension and Aid and Attendance count ride costs

The VA pension is needs-based. VA pays the maximum annual pension rate that fits the household, minus the household’s countable income. Unreimbursed medical expenses, including rides, come off countable income once they pass a threshold, so they can raise the pension.

Aid and Attendance is an increase on top of the pension for a veteran or survivor who needs another person’s help with daily activities such as bathing, feeding, and dressing, who must stay in bed most of the day because of illness, who lives in a nursing home because of a disability, or whose eyesight is limited to 5/200 or less in both eyes or a field of 5 degrees or less. The rates below took effect December 1, 2025.

Add $2,984 for each additional dependent. The net worth limit for pension eligibility is $163,699 for the period from December 1, 2025, through November 30, 2026.

How VA counts rides

Under 38 CFR 3.272, unreimbursed medical expenses paid during the 12-month period VA uses are left out of income to the extent they exceed 5 percent of the basic maximum rate. That basic rate includes dependents but not the Housebound or Aid and Attendance increase. The expenses can be for the veteran, a spouse, children, or a parent or other relative in the household whom the veteran has a moral or legal obligation to support.

Rides count under 38 CFR 3.278:

• Fares. Taxi, bus, or other paid transportation to and from a health care provider.
• Driving. Mileage, parking, and tolls for medical trips in a privately owned vehicle, with mileage limited to the federal government’s rate for employees who use their own cars.
• Reimbursements. Only the part not repaid by VA travel pay or anyone else counts.
• Paid companions. Payments to an in-home attendant count when the attendant provides health care or custodial care, in line with the hours worked. An attendant without a health care license qualifies when your parent receives Aid and Attendance or Housebound benefits, or when a doctor, physician assistant, certified nurse practitioner, or clinical nurse specialist states in writing that your parent needs the care.

For example, a veteran with no dependents has a threshold of 5 percent of $17,441, or about $872. If that veteran paid $2,000 for rides in a year and had no other medical costs, about $1,128 would come off countable income, and the pension would rise by the same amount, up to the maximum rate. VA reports these costs on VA Form 21P-8416, the Medical Expense Report, whose mileage section asks who traveled, where, the total miles, the date, and any amount reimbursed. For the veteran’s own trips to VA care, see our guide to rides to VA appointments.

Taxes, HSAs, and FSAs when you pay a parent’s rides

Rides taken mainly to get medical care count as a medical expense for tax purposes. That covers bus, taxi, train, and plane fares and ambulance service. If you drive, count actual gas and oil costs or the standard medical mileage rate, plus parking and tolls, but not depreciation, insurance, or repairs. For 2026 the medical rate is 20.5 cents a mile through June 30 and 23.5 cents a mile from July 1, after a midyear increase. The 2025 rate was 21 cents. The travel costs of a nurse or other person who can give injections, medications, or other treatment also count when the patient cannot travel alone. Wages for services of a kind a nurse generally performs count as well, even when the worker is not a nurse, after setting aside any time spent on household chores. Choosing to travel to another city for an operation for purely personal reasons does not count, and neither does travel that only improves general health.

Counting a parent’s rides on your return

Only the part of total medical costs above 7.5 percent of your adjusted gross income is deductible, and only when you itemize on Schedule A. To include a parent’s costs, the parent must be your dependent, either when the care was given or when you paid. A parent can be your qualifying relative if you provided more than half of their support. You can still include their medical costs if they would be your dependent except that they had gross income of $5,200 or more in 2025 or filed a joint return. Under a multiple support agreement among siblings, only the sibling entitled to claim the parent can count the parent’s medical costs, and only the part that sibling paid and was not repaid for.

HSAs and health FSAs

An HSA can pay qualified medical expenses for you, your spouse, your dependents, and anyone you could have claimed as a dependent except for their income or a joint return. Keep records showing each payment went to a qualified expense that was not paid or reimbursed from another source and not taken as an itemized deduction. Money used for anything else is taxed, plus a 20 percent additional tax, unless the payment comes after you turn 65, become disabled, or die.

A health FSA pays back only expenses incurred during the coverage period. Before it pays, you send proof from someone independent of you that the expense happened and what it cost, along with your own statement that no other coverage paid it. An FSA cannot pay ahead for rides that have not happened yet. A ride company is that kind of outside party, so ask it for a receipt showing the date, the amount, and the medical destination.

Records to keep for every ride

One set of records covers the VA form, a tax return, and an HSA or FSA claim. Keep, for each trip:

• the date
• where your parent was picked up and the medical provider they went to
• the miles, if you drove
• the amount paid, who paid it, and how
• any repayment received, such as VA travel pay
• the ride company’s receipt or invoice

A ride company that bills a family directly can provide most of this on its receipts. Our guide for operators on private pay rides shows what a useful receipt includes, and our guide to medical escorts for seniors covers paying for a companion who goes along.

For ride companies that bill families directly

Families who pay for rides themselves may need a record of each payment for the VA or a tax preparer. Ride companies on HealthRide take card payments from riders and facilities through a secure card processor, using pay links and saved cards. Cash and checks are recorded in the same list, matched to the trips and invoices they paid. See how payments work.