Medicare beneficiaries for the first time began signing up for federally subsidized drug coverage yesterday, and early indications were that many will need an antidote for the outbreak of confusion and frustration that accompanied it.
The 43 million people eligible for the new benefit have at least 40 plans to pick from on average, reflecting the competition that Medicare officials say promotes lower costs -- but also more head-scratching. Moreover, one of the most efficient ways to get comparative information is via the Internet, a medium with which many seniors are uncomfortable or unfamiliar.
Annapolis resident Michele Ryan Crofoot, 66, a retired developer who considers herself savvy about both numbers and the Web, said she has been unable to figure out whether to switch to Medicare from her current drug coverage.
"You read all these things about 'Go to the computer and find these plans,' " said Crofoot, who has attended two seminars on the subject. "I've tried it, and I just get so frustrated. For me, it's slow, but it's hard for me to compare. I don't even know if I'm doing it right. . . . This is driving me crazy."
Health and Human Services Secretary Mike Leavitt said enrolling millions of people in the most significant new benefit in Medicare's 40-year history will be a "monumental challenge" but worth it.
"Enrollment may start off slowly, but we're confident that over time seniors are going to like the benefit," Leavitt said in a conference call with reporters late last week. "It saves them money. It helps them stay healthy. And it gives them the peace of mind that they need so that they'll never have to worry about losing their savings to the high cost of prescription drugs."
The new drug benefit is expected to cost the federal government $720 billion over the first 10 years. The average senior is expected to pay about $32 in monthly premiums and an annual deductible of $250. Medicare covers 75 percent of drug costs up to $2,250. The coverage then stops until the recipient has spent an additional $2,850 out of pocket, after which Medicare covers 95 percent of all additional drug costs.
Coverage will take effect on Jan. 1 for anyone who signs up by Dec. 31. Eligible beneficiaries can enroll as late as May 15 without penalty. Some Democrats in Congress say that is not enough time and are pushing legislation to extend the enrollment period by six months.
For people who already have drug coverage as good or better than Medicare's, the right decision may be to stay put, officials said.
"You've got plenty of time to make a decision, and we have plenty of help available," said Mark B. McClellan, head of the Centers for Medicare and Medicaid Services.
Many seniors are expected to turn to relatives and community groups such as churches, senior centers and local nonprofits for help. Federal officials have run national ads and provided training and materials to thousands of local groups. More than 7,000 Medicare telephone operators also are on hand at 800-633-4227 to answer questions.
Medicare officials said it was too early to determine how many people signed up yesterday, but 135,000 people had called the toll-free number as of 3 p.m.
After nearly a month of delays, Medicare officials rolled out last week an interactive tool on the Web site www.medicare.gov. They say the tool will allow seniors to key in the names of the drugs they take and other information and to instantly receive a personalized list of drug plans in their area ranked by annual cost. With a few mouse clicks, officials said, seniors can choose a plan and sign up for coverage.
Ed Rubiera, 65, a retired General Motors Corp. manager who lives in Orlando, said he had 64 drug plans to choose from. He tried Medicare's online tool, but it left him with many questions about quantity limits and preapproval requirements. So he picked four plans and researched them independently -- spending long stretches on the phone with insurance company representatives -- before settling on one sponsored by AARP.
"There is still a lot of mystery involved in this," said Rubiera, who will save about $717 a year from his annual drug bill of $2,409. "I can't make this my life. I'm satisfied that I made a good enough decision for the time being."
More than six in 10 seniors said they understood the drug benefit "not too well" or "not well at all" even though 74 percent said they had received information about it, according to a recent survey by the Kaiser Family Foundation and the Harvard School of Public Health. Nearly three-quarters of those surveyed said the large number of choices "makes it confusing and difficult to pick the best plan."
Robert M. Hayes, president of the Medicare Rights Center, a nonprofit group that helps seniors navigate Medicare, said his organization was swamped with calls yesterday. "At this point, we're urging calm and just wait a few weeks to give yourself time to sort things out," Hayes said.
The problem, he said, is that the online tool -- the best hope for making an intelligent choice -- remains difficult to access at times and plan providers continue to tweak their prices and terms.
Gary Karr, a Medicare spokesman, said officials are working to expand the capacity of the Web site. "There's been times when it's been extremely slow or just has stopped working," he said.
Betty Sicher, 71, a nurse from Spring Valley, N.Y., has already made her choice. She will skip the Medicare benefit and keep paying $150 a month to buy her drugs from Canada, she said.
"I'm truly not so sure that this [Medicare] plan is really going to work for me," she said. "There's no control over the prices of the drugs, so if the drug prices go up, my premiums are going to go up. I'm locked into an insurance company for a year. If they change their formulary and I can't get the drug through them, I have to go elsewhere to get it. . . . I decided it just wasn't worth it."