MEDICARE RX JUNGLE

Seniors may have a tough time fighting through the tangle of regulations, choices, plan lists, special provisions, penalties and warnings of the new Medicare D prescription drug program, for which signups start today and extend to May 15, 2006 without penalty.

If they make it – and many could drop out in confusion – the older people who use lots of expensive drugs will face a nasty shock sometime next summer: the so-called “doughnut.” This is a gap in government payments that occurs after a user has bought $2,250 worth of drugs, with the insurance plan paying 75 percent of the cost. At that point, plan contributions stop cold and the user must pay 100 percent of the costs until the out-of-pocket expenditure total reaches $3,600. From then on, the plan pays 95 percent of the costs until the end of the year.

Other headaches include a regular monthly premium, averaging $32 but possibly as high as $85 and going up in future years, which can be deducted from Social Security benefits. It goes on indefinitely unless the user quits the plan. Americans are used to such continuing charges, for services like cable TV, telephones and Book-of-the-Month Club, but they do add up. The program does nothing for those who buy their drugs from Canada. Stiff penalties are imposed for late signups.

In some cases, the program will certainly help the elderly buy prescription drugs, but it will also funnel an estimated $741 billion of federal money over the next 10 years into the pharmaceutical companies with a cut going to the insurance companies that run the plans.

Medicare has been slow getting its Web site ready. When it tells you to click on your state to find available plans, it lists 43 of them, but when they are listed by county, only 12 Maine counties show up. A 20-minute tutorial flips through one chart and table after another, probably too fast even for a young person to comprehend. And, on many computers, the print is far too fine for many aging eyes.

Clumsy as it may seem, however, Medicare’s Rube Goldberg prescription drug program has its good points. It claims to pay half your drug costs – a big saving for the many Americans who have no drug insurance. Best of all, it provides generous insurance covering the astronomical prescription costs that can come with catastrophic illness.

So the best advice to people on Medicare is not to rush into signing up – they have until Dec. 31 for coverage starting Jan. 1, 2006, and until May 15, 2006 to avoid penalty -but to consider carefully whether signing up may be to their advantage.

They can begin at www.medicare.gov, which provides a good background, or call Medicare at 1-800-633-4227.