Bills Soar As Many Hit Gap in Drug Plan

Anderson is managing for the moment, thanks in part to two drug vouchers her doctor supplied and a discount card she obtained through the county. Yet she worries. Unless she can switch to a plan without a gap -- and afford its higher premiums -- she'll face the same math all over again Jan. 1.

"I'm just one of many," she said.

Exactly how many remains a contentious question. Before the program's start, the Congressional Budget Office and the Kaiser Family Foundation both projected that about 7 million recipients would be affected this year.

Then last month, a report for the national Health Leadership Council, a coalition of health care executives, pegged the number at 3.4 million. This month the Campaign for America's Future report put the estimate back at 7 million.

Democrats on Capitol Hill have called for change. One proposal would have Medicare, not the drug plans, negotiate directly with the pharmaceutical companies; supporters say the savings could help eliminate the gap. Another measure, introduced by Sen. Barbara A. Mikulski (D-Md.) and three colleagues, would waive the premium for any month when a senior lacks coverage.

Tave Kaufman, 74, of Bethesda calculates that he's better off regardless. Although he and his wife quickly spent their way past the first threshold, their total cost should be less by year's end than in 2005. "It better be," he said, "or else we took the wrong plan."

But his equanimity is being tested. With a brother, he's paying for the prescriptions of his 88-year-old aunt. Her priciest medication runs $450 a month.

Kaufman can only laugh. "You're looking at a trio of doughnut-holers," he said.