Currently the signup for Medicare Part D Prescription Cards is occurring.

This represents the greatest change in Medicare since it started. Enrollment began on Nov. 15. All of those who are enrolled by Dec. 31, will possess a card to provide discounts on prescriptions. Everyone enrolled in Medicare Part A and/or Part B is eligible to have a card.

The cost of prescriptions for many are extremely high -- $1,000 per month and higher. Even with lower monthly cost, it remains more than many can handle. Help with prescriptions is something that older Americans have requested for years. Now that we have an opportunity to have help with prescriptions, many are completely confused.

There is something like 21 companies offering plans in Missouri --10 of them are offering plans nationally.

Each company is required to follow guidelines set up by the government and may offer as many as three different plans. In many respects each one is good and there is not that much difference between companies. One person who has been reviewing several plans said that there is a difference.

The amount of prescriptions taken per year will determine if within a company the lower price plan or a higher plan should be taken. According to a recent bulletin sent out by AARP the company with higher premiums is not necessarily the company with the best plans.

What is important is to take a plan that has your prescriptions. The company may request that a person try another formula that will do the same job, but less expensive. Some of the expensive prescriptions have higher co-pay. The company may suggest another formula. If the company does not offer the formula that is desired, there may be another formula that they do offer that will work. The doctors may need to prescribe another formula. There is bound to be problems and questions with many beneficiaries when prescriptions are obtained for the first time in January.

More than one person has said that the program is hard to understand. They are also wondering why they made it so difficult to understand. The government has set up requirements and guidelines. Every "i" must be dotted. There are penalties if the requirements are not followed.

One director of a health care facility said that they do not know how they are going to handle the sign up for the cards. The industry has not received information. Even though this has been in the works for at least two years -- the government was not ready when the time came.

One person signed up for a Medicare Prescription Card on the first day the sign up became available Nov. 15. That way she would not need to worry about getting signed up. The other day she was wondering what she signed and was afraid that it could do away with her Medicare Supplement and she did not want that to occur. They are two different things.

Another person recently signed up for a Medicare Supplement for the first time. He was able to get signed up with the Veterans Administration, which is a better plan than the Medicare Prescription Card. He is in good health and does not require medical care at this time. He will still use civilian doctors, especially in an emergency. He said that he did not need the supplement any longer because he can get the medication from VA. In his mind the Medicare Supplement is the Medicare Prescription Card. His wife reminded him that they were two different things and if he was in an accident he might need the supplement.

One lady got confused with the letters for Medicare and for the supplements. With Medicare you have plans A, B, C and D. With the supplements you have a choice of A, B, C, D and etc. Others are most likely the same way, not knowing what they have.

At present, she has Medicare Part A and Part B and plan F with the supplement. She will be signing up for Part D Card as the retail price for her medications will be more than $1,000 a month. It is hard for the average person to keep everything straight.

Even though Social Security sent out information about people signing up, indicating they could get help with the cost of Medcare Plan D, there are many who might be qualified and don't know it. A packet was sent out to each person on Medicare. I stopped by the Social Security office again this week to get packets for beneficiaries who may be eligible. I learned that they will help to fill out the information, and get it right on the computer at that time. This will be helpful.

A major problem is that there are individuals and companies who are violating the rules. This includes phone solicitation and door to door sales. There have been news articles that individuals and companies are being investigated.

The plan that was first sent out included a $250 deductible. Many of the plans do not have a deductible; instead have a co pay during this period. After the total cost of the drug cost reaches $2,250 then the plan is designed for the out-of-pocket to be 100 percent. This will be and expensive period. Most plans will not pay anything during this period. Generally, if the plan pays during this time, it is for generic drugs.

Once the catastrophic coverage is reached there will be low out-of-pocket cost. Remember a threshold is reached when the total drug cost reaches $2,251. Then some of the plans change how much is required out-of-pocket.

Another plan may require that the total costs of drugs reach $5,100. The later may have the potential of being reached first. Another plan may provide the catastrophic for either the cost of drugs or out-of-pocket -- which ever is reached first. Is there any wonder that there remains much confusion? #