COMPARING THE COSTS: Navigating the maze of offerings is tricky even for the computer-savvy

Aptos resident Joel Wallock, 66, a semiretired lawyer, describes himself as "one of those dot-the-i's kind of guys."

So with enrollment for the new Medicare prescription drug plans scheduled to start Tuesday, Wallock wanted to nail down a plan for himself. He put in several hours during a two-week period, visiting his pharmacist and calling toll-free numbers for Medicare and insurance providers to find the best plan for the five prescriptions he takes for asthma, eczema and prostate problems.

Wallock figured out a way to keep his outlays down to $2,700 a year by buying two of his prescriptions in Canada once he hits the Medicare plan's doughnut hole, where beneficiaries pay 100 percent of drug costs. That comes to 21 percent more than he pays now.

Still, he's going to sign up for the Medicare plan because his present insurance stops at $2,500 worth of drugs, while Medicare plans pay 95 percent of drug costs over a certain amount. Basically, he's joining the Medicare plan as a hedge in case he has catastrophic prescription needs in the future.

Wallock is the exception among Medicare recipients in that he successfully navigated the system to figure out which plan would work for him. But it wasn't easy.

"Even with my ability as a lawyer to do research, I found the thing to be a total quagmire," he said.

More typically, Medicare recipients are struggling with whether they should sign up, and which plan to pick.

A study released last week by the Kaiser Family Foundation found that 61 percent of seniors said they have no or minimal understanding of the new drug benefit; 35 percent said they do understand it. Only 39 percent of seniors said the plan would help them personally; 49 percent said it would not.

More than 4 in 10 seniors (43 percent) said they don't yet know whether they will enroll in a Medicare drug plan for 2006, while 37 percent do not plan to enroll and 20 percent do plan to enroll.

Among the seniors who plan to enroll, out-of-pocket costs for each prescription was the top concern for 35 percent, while 19 percent cared most about which drugs the plan would cover and 16 percent said the cost of monthly premiums was their top issue in selecting a plan. Twenty percent said all those factors are important.

In Wallock's case, the fact that his total cost would be higher than what he currently pays came as a surprise.

"It sure slapped me in the face when I looked at this," he said.

The AARP plan Wallock selected costs $23.20 a month and has no deductible. (Most plans have a $250 deductible.) The plan would cost him $3,560 a year, he said -- $278 in premiums, $1,950 in co-pays and $1,350 in the doughnut hole gap -- if he bought all the medications he now takes through it.

Right now, his out-of-pocket drug expenses are $2,230 a year -- $730 for premiums, a $250 deductible and $1,250 in co-pays. His current co-pay is 50 percent of the drug costs after fulfilling the deductible. He buys all his drugs from Canada so that the initial price is lower.

In trying to keep down his costs under the Medicare plan, he realized that he could buy two prescriptions from Canada once he hits the doughnut hole.

Medicare plans do not cover drugs purchased in Canada, so he will pay the full Canadian price. That still comes out to much less than what his Medicare plan would charge while he's in the doughnut hole of no coverage.

Some Medicare recipients are making a different choice from Wallock, concluding that they don't need the new plan because they already have adequate drug coverage through an existing policy.

That was the case for Dick Steinbach, 70, of Novato. He retired from Pacific Bell in 1987 with health insurance through United Health Care and prescription coverage through Caremark.

Steinbach received a letter last month from Caremark saying that its coverage is as good as or better than Medicare plans will offer.

All Medicare recipients who already have prescription coverage are supposed to receive such a letter from their insurer, company or union explaining whether their coverage is at least as good as Medicare's. If it is, they can keep their policy and not have to pay a penalty if they later sign up for Medicare. (People should keep a copy of that letter.) Otherwise, those who sign up for Medicare drug coverage after May 15 pay a penalty of 1 percent more in premiums for every month they delay.

Steinbach wanted to figure out for himself whether a Medicare drug plan would save him some money on his five medications for high blood pressure, high cholesterol and prostate problems. He describes himself as computer literate and reasonably Internet-savvy but he couldn't "penetrate the maze" of Medicare's Web site to figure out how its plans would compare to his coverage. He's likely to just stick with his existing coverage.

According to the Kaiser survey, among the 80 percent of seniors who said they will not enroll or don't know whether they will enroll, 60 percent said they already have insurance that covers prescriptions.

When it enacted the Medicare drug plan, Congress wanted to encourage employers to continue prescription coverage for retirees, so it built in money for Medicare to pay subsidies to companies with such policies. Medicare is expected to spend $71 billion on employer subsidies during the next eight years.

Not all Medicare recipients are seniors. In 2003, there were 35 million Medicare enrollees over 65 and 6 million enrollees under 65 who qualified for the coverage because they are disabled.

Meghan Elizondo of San Jose is 33 and on Medicare because she is disabled by inflammatory arthritis. She takes at least nine medications that would cost about $8,500 a month if she had to pay full price. Right now, she has health insurance, including some drug coverage, through her husband's former employer. He was laid off about six months ago but pays $400 a month to continue the coverage.

Elizondo spent hours typing all her medications into the Medicare Web site and hasn't been able to find a plan that covers all of them.

As someone who suffers from a disease that may progress or stop responding to certain drugs, she worries about being locked in to coverage that won't change to accommodate her health needs. Medicare drug plan enrollees can switch plans only once a year.

"I'm immuno-suppressed because they treat inflammatory arthritis by knocking down the immune system," she said. "If I get an infection, I have to take antibiotics, and those are very expensive. It makes it nearly impossible for me to make an educated decision. It's frustrating, very frustrating."

A Medicare spokesman said that in cases like Elizondo's, patients should see if there are generic equivalents to their drugs and try entering those into Medicare's online plan finder to get as many drugs covered as possible. If patients develop new symptoms that require additional drugs, they can apply for an exception and are supposed to receive a swift decision. If their application is rejected, they can appeal, but that is likely to be a lengthy, complex process, the spokesman said.

Elizondo said her best hope is that her husband, a computer programmer, will find a job with good health insurance before May 15. "The whole Medicare prescription plan is just so inadequate. It's worse than not having it," she said. "It makes some people think that now the problem is fixed and they can ignore it."

E-mail Carolyn Said at csaid@sfchronicle.com.