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Beverly Kidder explained Medicare D one recent day to a packed audience of seniors at Hamden’s Thornton Wilder Hall. Or tried to explain it.

Kidder, of the Agency on Aging of South Central Connecticut, based in New Haven, spoke honestly but carefully about the new benefit, which goes into effect Nov. 15. Seniors, the disabled and health-care workers are scrambling to figure out the confusing system that many see as more of a gift to private managed-care companies than to those struggling to afford health care.

"Medicare D is a voluntary program," Kidder said. "Now I’m going to contradict myself. If you’re on another plan you might have to sign up. So technically it’s voluntary but in reality it’s not."

Before coverage kicks in there’s a $250 annual deductible. After that is reached patients have a co-pay of $1-$5 per prescription until they’ve gotten $2,250 worth of drugs.

Then they fall into what Kidder called the "doughnut hole. When you fall into this deep, dark hole you’re still paying your premium" but Medicare Rx is paying nada. The patient has to spend a total (including the initial $250 deductible) of $3,600 out of pocket before Bush’s plan kicks in again. (This is commonly known as catastrophic coverage, when out-of-pocket expenses are unusually high.) When coverage resumes, 95 percent of drug costs are covered.

Medicare beneficiaries will be asked to choose among scores of drug plans, offered by HMOs and other private entities, to which they pay a monthly premium. The average Connecticut premium will be $30.27, and there are 44 "stand-alone" prescription drug plans (PDP) here.

Only those who are solely covered by Medicare (don’t have other health insurance) have the choice of whether they want to sign up. But they’ll be punished if they change their mind down the road. They will be charged a higher premium for every month they didn’t enroll; the clock starts ticking on May 15, 2006. And instead of the $1-$5 co-pay, these penalized folks will have to fork over about 25 percent of the prescription cost for the rest of their lives.

People who are on both Medicare and Medicaid will lose their Medicaid prescription benefit on Jan. 1, 2006, and will be automatically enrolled in a PDP by Dec. 31, 2005. They can choose one or one will be chosen for them.

There’s no drug co-payment or monthly premium under Medicaid, but there will be under Medicare D. Another drawback is limited drug choice. Medicaid covers most medicines; PDPs will use a formulary -- a list of covered drugs -- that will vary depending on the plan.

People who are covered by Medicare and the state drug plan, ConnPACE, are also required to enroll in Bush’s drug deal. Again, people will lose a plan that has no drug formulary, no monthly premium to one that has both.

It gets worse. If someone is diagnosed with a new disease, there’s no guarantee that his or her PDP includes in its formulary the new medication(s) needed to treat the condition.

"You’re out of luck until the end of the year when enrollment is open again," Kidder said, at the Oct. 26 seminar. That’s when people can shop for a new drug plan.

She also talked about how confusing the whole shebang is. "Is choice a good thing or bad thing? We want choice in the supermarket. But too many choices can be confusing," Kidder said.

"Is (Medicare D) good?" she said. "I don’t think it’s going to be the nightmare as some say, but it’s not going to be easy for the consumer."

A Benefit for … Whom?

Enrollment starts Nov. 15 for the new Medicare prescription drug coverage. The Bush Administration has been touting it as a great benefit to seniors and those who are disabled.

However, some conclude it will really benefit the fabulously wealthy managed health care and pharmaceutical industries, and help privatize the federal health insurance program.

"There’s a lot of profit to be made in this," said Judy Stein, executive director of the Center for Medicare Advocacy in Willimantic. About $10 billion from the federal government will go to private drug plans (mostly run by HMOs), she said. "The money is good."

Medicare D, also called Medicare Rx, is supposedly designed to help the most vulnerable populations buy medicine. Medicare does not currently cover most prescription drugs.

Though not quite off the ground yet, the new drug benefit is proving to be controversial at best. It’s also confusing, say advocates, with too many plans to choose from, all having different criteria and approved drug lists.

Some fear seniors will get ripped off while private insurers and drug companies beef up their bank accounts. And they don’t like the idea that Medicare, a public program, is going down the private, corporate path.

"Private insurance has a history of not meeting the needs of elderly and disabled people," said Stein. She said currently there are two or three Medicare managed care plans in Connecticut. With the Bush Administration’s new "benefit for the elderly and disabled," about 14 more HMOs will enter the scene.

"This is all about Medicare managed care," she said. "It really is the beginning of privatization of Medicare. The federal government is going to become the largest purchaser of prescription drugs. So there’s a huge new market for the pharmaceutical companies."

Will it Work?

"How I feel is irrelevant. I’m trying to make this work for our clients," said Stein. "But it’s providing too much choice through private plans. I think Medicare should be an insurance program that meets the needs of this vulnerable population. It has been proven to be less expensive to the taxpayers to run it as a public program instead of private.

"It’s a philosophical divide between those who think Medicare should be public versus those who believe it should go private.

"This experiment has moved Medicare to the private sector, and will provide billions of dollars to the private insurers and pharmaceutical companies," she said.

Say What?

It remains to be seen what good this will do for people like those gathered at the Oct. 26 seminar in Hamden.

Right after the seminar, Agnes Farrar said she thought Kidder’s presentation was informative. "She did it so everyone can understand. It’s a good idea -- if it works," she said.

"I think she was very honest," said Maire Terrace. "But I just wish she would have repeated the questions from the audience because some of us can’t hear very well."

Said her friend Mary Alberteini: "We’re still confused."

A woman walking to her car complained, "They’re already charging us $200 for the Medicare (Part B) premium and they’re charging us for this, too?"

For more information: The Medicare Rights Center, the Center for Medicare Advocacy, and the Kaiser Foundation.