Published 2:15 am PDT Monday, August 22, 2005

Dear Mom and Dad:

Medicare is changing and you've got to make some decisions about the new drug benefit that starts Jan. 1. The changes are confusing and complex, so you should get help. Take my word for it, you're not going to be able to get through this on your own.

You've got a few months, so there's no need to panic. Enrollment begins Nov. 15. The deadline is May 15, 2006, but you can't dillydally. There are penalties for those who sign up late. You should get started on this now.

Unfortunately, the decision to join will not be an easy one. Congress could have designed a simple program, where the government negotiates drug prices and the elderly pay a uniform premium. Instead, Congress passed an incredibly complicated program.

Step 1: Call your pharmacist, get a list of all your prescriptions and their cost. Then talk to your doctors and try to anticipate what drugs you might need in the next year.

Step 2: Get help. You are about to have to make decisions that are highly complex. Fortunately, residents of California can contact the California Health Insurance Counseling and Advocacy Program (HICAP) at (800) 434-0222 or visit the organization's Web site at www.calmedicare.org.

If you're reluctant to ask for help, let me show you the kinds of things you'd have to work through if you attempted to do it on your own:

First, you have to figure out whether you will benefit from the program. In 2006, premiums will be $32.20 a month on average, or $386.40 a year. (Maybe; the Kaiser Family Foundation assumes the average will be $420).

Beyond the premium cost, for the first $250 in drug costs you'll pay 100 percent out-of-pocket.

For the next $2,000, you pay 25 percent.

For the next $2,850, you pay 100 percent.

For drug costs after that, you pay 5 percent.

(Do you have a headache yet? Don't even think about getting a prescription for it.)

Once you figure out your costs under the new program, then you have to decide whether to keep your existing drug insurance (if you have any), pick a private company that will administer the Medicare drug benefit - or go without drug insurance.

This decision also is very complicated. You won't get information from the government on particular Medicare plans until mid-October, but you should know what to expect.

Under the new Medicare program, different companies will cover different drugs, so you'll have to contact each company separately to find out whether the drugs you take are covered. You'll also need to check with each company to find out whether the pharmacy you use is part of the plan's network.

And while the national base premium in 2006 will average $32.30 a month, each company will set its own premiums. Some plans will charge more; some will charge less. Again, you will have to look at each plan and decide what is best for you.

If you know of any low-income seniors who are eligible for both Medicare and Medicaid, be sure to tell them that they will automatically be enrolled in a plan if they do not sign up for one on their own. Their old Medicaid coverage will end Jan. 1, 2006. These people should get help immediately on how to join a plan of their choice.

Others may not fit that category, but they may still be eligible for a low-income subsidy. Make sure that they know they have to apply separately for that assistance. I realize that at age 75 trying to figure this out will be a burden on you, but you'll just have to get through it.

If you're not too worn out by the experience, contact your members of Congress and tell them to change the new Medicare drug program to make it more customer-friendly. All of us in the younger generations sure would love to see this get fixed before we're eligible for Medicare.

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Drug calculator

The Kaiser Family Foundation has a nice calculator that helps. It shows that for drug costs less than $800, you'd pay out more than you'd get in benefits. On the other hand, if you have $4,000 in drug costs, you'd pay $2,920 out-of-pocket. If you have $5,200 in drug costs, you'd pay $4,025 out-of-pocket.

Check it out at www.kff.org/medicare/rxdrugscalculator.cfm.