You asked for information on the federal Medicare program’s nursing home coverage, particularly (1) how long Medicare will pay for nursing home care and (2) how an individual becomes eligible for this assistance.

Medicare pays for a limited amount of skilled nursing home care for up to 100 days in each benefit period. A benefit period starts when the patient enters a nursing home and ends 60 days after he has been discharged; the next time he enters the home a new benefit period starts. The program pays the full cost for the first 20 days. For days 21 through 100 the patient pays $ 109. 50 per day and Medicare pays the rest. After 100 days, Medicare pays nothing.

To be eligible for this coverage, the patient must need skilled nursing care or rehabilitation services, not just custodial care and must enter the nursing home after a related three-day hospital stay. If the patient has enrolled in a Medicare HMO that has a contract with a nursing home, the HMO may cover more of the costs. In addition, some private Medigap insurance policies may also cover some of what Medicare does not pay. Medicare will not pay if the patient only needs custodial care, such as help with bathing, dressing, eating, using the toilet, or other activities of daily living. In such situations, the patient could perhaps rely on private long-term care insurance or, if he has very low income and assets, the state-federal Medicaid program.

A Center for Medicare and Medicaid Services publication about Medicare nursing home care (publication number 10153) is available at:

http: //www. medicare. gov/Publications/Pubs/pdf/10153. pdf

Medicare has two parts: Part A covers hospital stays, nursing home stays, and certain other services and Part B pays for doctors’ bills and other outpatient services. People become eligible for Medicare at age 65 if they or their spouses worked for at least 40 quarters (10 years) and paid Social Security and Medicare payroll taxes or if they receive Railroad Retirement benefits. Younger disabled people who have received Social Security or Railroad Retirement disability payments for 24 months are also eligible, as are people (as soon as they are diagnosed) with Lou Gehrig’s disease or end-stage kidney disease that requires dialysis or a transplant. Legal immigrants who are permanent residents can also qualify if they or their spouses worked and paid payroll taxes. Eligibility does not depend on a person’s income or asset levels and benefits are the same for everyone, regardless of income or wealth.

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