Mary Jane Cremen hasn't paid much attention to marketing pitches coming in the mail about the Medicare Part D prescription drug program.

"I've been throwing things out," Cremen said. "I've been very much confused."

With sign-up time nearing, the Naples resident and her husband, Joseph, plan to give the mailings more serious thought. The couple pay about $400 a month for prescriptions.

Combine the bureaucracy of the federal government, insurance jargon and the powerful insurance industry and what results is bewilderment and uneasiness among senior citizens over the voluntary prescription drug program that takes effect Jan. 1.

Anyone 65 and older who is eligible for Medicare can sign up for a prescription drug plan. A frequent misunderstanding among seniors is that the drug benefit only will serve the low-income.

Others believe they can't afford to sign up for a drug plan, although assistance with premiums and deductibles will be available for eligible low-income seniors from Social Security.

"I just had two people the (other) morning who said they can't afford it," said Betty Gamel, with the Senior Friendship Center in Naples. "I said wait a minute."

Many seniors mistakenly tossed out applications for financial help sent from Social Security. They should call their local Social Security office to see if they qualify for assistance and to apply.

"A lot of elderly people, when they get all this information, they are so confused," said Evelyn Barger, assistant coordinator in Collier County for Serving Health Insurance Needs of Elders.

SHINE is a state-sponsored program where volunteers, who are all seniors, provide unbiased counseling to older citizens about insurance options that fit their needs. Now the volunteers will spend their time helping seniors make sense of the new drug coverage.

The U.S. Centers for Medicare and Medicaid in late September approved 18 "stand-alone" prescription drug plans from insurance companies for Florida residents. Not all the plans will be available in Southwest Florida. A "stand-alone" plan works with traditional Medicare coverage.

In addition, a few managed-care plans with Medicare benefits, some extra services and drug coverage will be available to Southwest Florida seniors. These are called Medicare Advantage plans.

Insurance companies were given the green light by CMS to start marketing their plans Oct. 1. Enrollment begins Nov. 15, and not before then, for coverage to take effect Jan. 1. Seniors have until May 15 to sign up for a plan to avoid penalties if they wait.

The 40 SHINE volunteers in the seven-county region of Southwest Florida stand ready to help Medicare-eligible seniors get a better understanding of the Part D program. But it's not easy.

"It's been a real struggle to stay on top of all the information," said Leigh Wade, executive director of the Area Agency on Aging in Southwest Florida, based in Fort Myers. "The good thing about SHINE volunteers is they are not paid by an insurer; they are not affiliated with a particular group."

The volunteers are available to speak to senior groups in the community or respond to calls at the agency's elder helpline at 1-866-413-5337. The caller will be referred to a SHINE volunteer to have their questions answered. If the line is busy, seniors are advised to leave a message and a SHINE volunteer will return the call.

In Collier County, seniors can call the SHINE number at 530-3364 at extension 230.

By Nov. 1, a volunteer should be answering the telephone during weekday morning hours in Collier or a caller can leave a message and their call will be returned, said Helen Hanley, the SHINE coordinator for Collier.

"If they call, we will call back and get a speaker to go out," she said.

In addition, SHINE volunteers will be available for one-on-one assistance, but senior citizens need to be prepared, Hanley said.

"We will sit and help them try to figure out their best plan, but they need to know their medications and which drug stores they prefer," Hanley said. "The big deal is picking out the best plan that covers as many of their medications as possible."

The choices among stand-alone drug plans will be plentiful, and each plan has its own formulary, or list of medications covered in the plan. All plans must comply with access to "medically necessary" drugs as well as to formulary standards, according to CMS.

"The less expensive plans have the more restrictive formulary," said Timothy Bejin, a marketing specialist in Naples with Senior Solutions, which is part of Pennsylvania Life Insurance. Bejin spoke to 20 seniors at a Part D seminar last week at the Senior Friendship center near downtown Naples. The center will host more seminars.

Typically, monthly premiums in stand-alone plans available in Florida start at $20, with a $250 deductible, reduced or zero deductible with co-pays for brand-name drugs, among other stipulations.

Some of the plans don't offer mail service for medications, some spell out which pharmacies must be used and some plans may only be regional, Bejin said. For people who travel a lot, they may want to find a plan that is effective nationwide, he said.

It is critical for seniors to understand program rules that can have negative consequences, Bejin and SHINE volunteers say.

For example, retirees should sign up for a Part D plan no later than the May 15 deadline, otherwise they have to wait until Nov. 15, 2006, to join. In that event, their premiums will go up at least 1 percent per month for every month they waited to sign up for a plan. Moreover, the higher premiums apply for as long as the senior is in the drug plan.

That means if he or she doesn't take any medications now, plans should be made for the future, sign up now to pay the lowest premium possible, according to CMS.

An exception to enrolling applies to seniors who get prescription benefits from their former employers, a union, or TRICARE (the main military health plan), when those retiree prescription plans have been deemed "as good" as what Part D plans will offer.

Former employers and unions are required to send letters to their Medicare-eligible retirees stating if their drug coverage is "as good" as Part D.

"If they have a letter saying their coverage is as good or better than Part D, then don't sign up (for Part D)," Barger, of Collier's SHINE, said. "If they sign up for Part D, they could lose all of their medical insurance with their former employer's carrier."

If a former employer drops prescription coverage next year, the retiree can sign up for a Part D plan and not be penalized.

For people with Medigap, or supplemental insurance, CMS has determined most are not as good as Part D plans, so the beneficiaries should join a Part D plan by the May 15 deadline to avoid the penalties later.

Seniors whose medications are paid for by Medicaid will be switched to a Part D plan effective Jan. 1, or they can switch to a drug plan of their choosing.

In addition, seniors who have been using Medicare-approved drug discount cards will see those cards terminate next year. Individuals can continue to use the cards until May 15 or until they sign up for a Part D plan, whichever comes first.

Other questions surfacing concern Medicare beneficiaries who have been buying their medications from Canada and whether they should stick to that.

Nancy Frustner, a Naples resident, has been purchasing her medications from Canada for a while. Her son, a financial planner, nevertheless says she needs to join a Part D plan to avoid the penalties later.

"And because he says the government is trying to stop the Canada connection," she said.

And if seniors aren't anxious enough about choosing the right plan for their needs, state and federal authorities advise them to watch out for con artists.

They should turn away door-to-door solicitations and should not give their Social Security numbers, bank account or any financial information to any callers or visitors. The best safeguard against a scam is to call Medicare's toll-free number to make sure the plan they are considering has been approved by Medicare.

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