Bills Soar As Many Hit Gap in Drug Plan

"He doesn't have a whole lot of recourse," Houghton said.

According to a report by the Campaign for America's Future, a Washington-based advocacy organization, seniors enrolled in the program at the start of the year will, on average, reach the doughnut hole Sept. 22. As the calls to agencies on aging and senior centers attest, many already have.

Retired teacher Elise Cain walked into her Silver Spring pharmacy last week for a pill she takes for diabetes, one of her dozen daily medicines. The 77-year-old woman had paid $20 in June. Her charge now is $175.24.

"I nearly passed out," Cain said.

Although the Medicare handbook clearly describes the coverage break, critics say most Medicare recipients, bombarded with advertising from private prescription plans, focused on deductibles and premiums and the drugs included.

"There was a lot of emphasis on signing up seniors. It was a crusade almost," said Stuart Guterman, a Medicare expert with the nonpartisan Commonwealth Fund. He doubts that many companies highlighted the doughnut hole in their marketing push. "That's not a selling point," he said.

Columbia resident Mary Ann Anderson, 81, was caught by surprise even though she had carefully reviewed the plans. She knew she had to choose wisely given the long list of medications she is taking after having double bypass surgery in December.

"It was a huge success," she said of the operation. "But not having the drugs could kill me."

This month, Anderson went to the store to pick up three refills. With her coverage, the bill had been about $125 a month. Suddenly, it had more than doubled.

"You hit the limit," the pharmacist told her.

"What do you mean?" she asked, bewildered.

She quickly learned. She also learned that the $14,952 she nets from Social Security annually made her ineligible for many assistance programs, including those offered by pharmaceutical companies. She spent five days on the phone trying to find alternatives, taking detailed notes of each conversation. She contacted elected officials, federal and state, and Howard County's Office on Aging. She asked her cardiologist for samples.