The briefing was about Medicare's new prescription drug program, but people at the Homewood House reacted with a fervor more typical of a camp meeting.

Murmurs rose last month from the audience at the housing complex as Bob Kubit, who counsels people on health insurance, and Dan Majewski, a public affairs specialist for the Social Security Administration, described the complications of the program.

Like circuit-riding preachers, Kubit and Majewski have made dozens of presentations in recent weeks to help local Medicare recipients get ready for the program, known as Part D.

For seniors, that means bracing for what could be an avalanche of information regarding the largest expansion in Medicare's history. Advertising has begun appearing, but the larger push lies ahead.

"You need to prepare yourselves," said Kubit, who coordinates Allegheny County's Apprise program, a free health insurance counseling program for Medicare recipients. "You're going to get a lot of mail from insurance companies, drug companies, stand-alone drug plans," he warned those at Homewood House.

Not just mail, but telephone calls and other marketing efforts will be employed as companies try to persuade people to sign up for the program, which begins Jan. 1.

"It's going to be madness," predicted Tom Snedden, program director for PACE, the state's prescription drug program for low-income people 65 and older.

Like the rest of Medicare, a health insurance program for people 65 and older and younger people with disabilities, Part D will be funded by the federal government. But the drug program, approved by Congress two years ago, will be administered through an array of private plans.

The government announced last week that 23 companies would offer stand-alone prescription drug plans throughout Pennsylvania and West Virginia in 2006. That is more competition than in any other region of the country. And even more health plans might offer the prescription benefit.

While some Medicare recipients will be enrolled in Part D for free, others will have to pay. They must decide if they want to enroll and which plan is best for them.

Medicare recipients can't choose a plan until Nov. 15, but the plans can begin marketing themselves to recipients Oct. 1.

"The gold rush starts in October," Snedden said. Medicare recipients "are going to be the nuggets."

"I wouldn't describe it as a gold rush," said Edmund E. Kroll, an analyst who follows managed care companies for S.G. Cowen & Co. in New York. "But it's a big opportunity and I think the companies, the better-positioned ones especially, want to make sure they have their ducks in a row when this whole thing kicks in. It's certainly a major new revenue and profit opportunity."

But for many, the coverage could be expensive.

Guidelines allow Part D plans to require a monthly premium, of about $32 and a deductible consisting of the first $250 of their drug costs. After that, enrollees might have to pay 25 percent of the next $2,000 in prescription bills. They then could fall into a "doughnut hole," where they might have to pay all of the next $2,850 in drug costs covered by their plans, before facing small co-pays for any additional drug costs for the rest of the year.

"Doesn't make sense," one listener at Homewood House muttered after hearing the rundown.

Participants could be spared some of those costs, however, because the drug plans can offer variations on the basic package.

Among plans available in Pennsylvania and West Virginia, for example, several will have monthly premiums of $25 or less, and many will have deductibles lower than $250, according to the federal Centers for Medicare and Medicaid Services.

Before signing up, Medicare recipients should compare plans and ask about out-of-pocket costs and how quickly those costs will increase, Snedden said. Another priority, he said, is to ensure that the drugs they need and the pharmacies they use are covered by the plan.

Initially, people facing a barrage of calls and fliers should concentrate on collecting information rather than making a choice, suggested Ray Landis, an advocacy representative for AARP Pennsylvania.

Making that choice will be easier for some than for others.

It should be simple for Medicare recipients who lack drug coverage and take lots of prescription drugs. They would have only small co-pays after paying, at most, $3,600 annually.

Retirees who have good drug coverage from their former employers also have a straightforward decision. They can probably do without selecting a Part D plan, though they have to confirm that the coverage they have is "creditable," that is, at least as good as Part D. Otherwise, Part D could cost them more if they sign up after the initial enrollment period, which ends May 15.

For those who enroll after that date, the monthly premium could be increased by 12 percent of the average premium for each year delayed in signing up.

Companies will be sending letters to former employees this fall to let them know if they have creditable coverage.

For others, the choice will be more difficult.

Medicare recipients who do not have prescription drug coverage and take few prescription drugs have to weigh the cost of being in Part D with their potential need for drug coverage. They also have to keep in mind that, because they lack creditable coverage, the cost of Part D could be higher if they enroll after May 15.

By contrast, people who receive government help paying for their Medicare premiums, those who receive Supplemental Security Income payments, and others who receive Medicare and Medicaid, so-called "dual eligibles," generally will be enrolled in Part D at no cost to them.

They will be assigned to a drug plan if they do not choose one, though Kubit said they would be better off selecting a plan that best meets their needs.

Other low-income people who may be eligible for full or partial subsidies to cover their costs for being in Part D must apply for the help, a process separate from enrolling in the program. The Social Security Administration has sent letters to nearly 19 million people urging them to apply for the subsidies.

In Pennsylvania, about 80,000 of the 200,000 people 65 and older who are enrolled in PACE would qualify for full subsidies. Kubit said those people should remain in PACE, but apply for the subsidies and later enroll in Part D, in part because they could have lower co-pays through the new federal program.

Signing up people who qualify for full subsidies could save the state $180 million a year in drug costs.

With that in mind, the state wants to enroll those PACE recipients automatically in a single drug plan. Snedden contends that automatically enrolling people in more than a few plans is not feasible before Part D begins in January. Federal officials have not supported the idea.

PACE will be mailing letters late this month encouraging the 80,000 people who qualify for full subsidies to apply and indicating that PACE will help them enroll in Part D, Snedden said.

The letter will suggest to the 120,000 other PACE recipients, and 100,000 people in PACENET, a state drug assistance program for people with higher incomes, that they not sign up for Part D.

State officials would like to sign up those people for the federal program, which would result in additional savings for the state, Snedden said. But for now, they are concentrating on the 80,000 PACE recipients who would qualify for full subsidies. Because PACE and PACENET offer creditable coverage, he said, members who do not sign up for Part D by May 15 would not have to pay more to join.

Still other Medicare recipients in Pennsylvania now receive prescription drug coverage through Medicare managed care plans or Medigap plans.

People in the Medigap plans could drop their prescription drug coverage and obtain coverage through a Part D plan, said Jack Vogelsong, coordinator of the state's Apprise program.

They also could continue with their current prescription coverage, but Vogelsong advised against doing so. Officials contend that, generally, people in Medigap plans would save money and get better coverage through Part D. And Medigap plans might not be considered creditable coverage, said Peter Ashkenaz, a spokesman for the Centers for Medicare and Medicaid Services. People in those plans who want to join Part D later might have to pay more.

Medicare managed care plans will offer Part D coverage, and people in those plans can continue them or switch to other plans.

Tomorrow: Companies, insurers already laying the groundwork to benefit from the new Medicare prescription drug benefit.

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