The message has been trumpeted for weeks on TV and radio ads, at the pharmacy counter and in the newspaper: Medicare beneficiaries can begin buying new prescription drug benefits this month.

But that simple message belies a more complicated truth.

The new program -- called Part D, for short -- brings a huge number of options to Medicare consumers. In the Pittsburgh area alone, the prescription coverage is available in more than 60 shapes and sizes, all carrying different levels of benefits at different costs.

Because the government benefit is being provided through private companies, the plans themselves are out in force pushing their options to Medicare beneficiaries. The government has created numerous resources to guide seniors to the best choice, as well.

This special section of the Post-Gazette, called "D is for Daunting," outlines all the options available locally and highlights the promise and peril of what the Bush administration calls the largest-ever expansion of Medicare. The buyer's guide is one of many tools Medicare beneficiaries might consult before making a choice.

But experts caution that no matter how much help seniors get, they still might not be able to make the perfect selection -- at least this time.

"It may be impossible for some consumers to find the ideal plan -- and it will certainly be time-consuming and difficult at best," said Jack Hoadley, a research professor at Georgetown University Health Policy Institute.

But Medicare recipients who take the trouble could save money, especially if they lack coverage now, he said.

"To some extent, people should think of this as maybe a two- or three-year decision," Mr. Hoadley said. "Some plan options may go away, cheap plans may become expensive -- people should maybe expect to change plans in the future."

Consumers can begin signing up for Part D plans on Nov. 15 and coverage starts Jan. 1.

Prescription drug coverage will be available in two ways:

Standalone drug plans, which provide pharmacy benefits to seniors who remain in the traditional Medicare program, will be offered for as little as $10.14 a month in Pennsylvania.

There are 52 different standalone benefit options in Pennsylvania, with the highest-premium plan coming in at $68.61 per month.

Inside this section, you'll find a chart that lists all these options and includes information about deductibles, copays and the dreaded "doughnut hole" -- the coverage gap that, in most plans, means consumers are on their own to cover a big chunk of medication costs.

Companies also will sell prescription drug plans coupled with Medicare Advantage plans -- Medicare health maintenance organizations (HMOs) and preferred provider organizations (PPOs) -- that manage doctor and hospital care.

Seven companies are offering Medicare Advantage plans in the Pittsburgh area, and all but one include prescription benefits.

In this section, you'll find a chart that lists the 21 options being offered by these seven companies, including some Medicare Advantage plans that don't include prescription benefits. Medicare consumers can enroll in an HMO or PPO that lacks drug coverage, and buy standalone benefits separately.

Facing a 'doughnut hole'
All the plans are based on the federal government's standard benefit, which calls for recipients to pay a monthly premium and a deductible consisting of the first $250 of their drug costs.

After that, recipients could pay 25 percent of those costs up to $2,250 in total drug spending.

Then they reach the "doughnut hole," when beneficiaries are responsible for all their drug costs.

Once the annual total spent on drugs reaches $5,100, coverage kicks in again and covers about 95 percent of the costs for the rest of the year.

Few plans work exactly that way, however, because they can offer variations on the standard benefit.

Rather than require that consumers pay 25 percent of costs in the first layer of coverage, many plans in the Pittsburgh area will require copays that vary based on whether the drugs are "generics," "brand-name drugs" or "preferred brands" -- terms that Part D consumers must understand.

Nine plans being sold locally provide some coverage through the doughnut hole, while two plans make the doughnut hole even wider, beginning the coverage gap at $1,800 or $1,850 in drug costs rather than $2,250.

And copays, deductibles and doughnut hole coverage don't tell the whole story about the plans.

Understand the variations
All of them cover drugs to treat a wide range of conditions, but the drugs that are covered, and pharmacies that participate, vary from plan to plan.

There are some techniques used to control drug utilization that may make the same drugs more costly or more difficult to obtain from some plans than from others. And discounted drug prices that enrollees will pay during gaps in coverage, such as the doughnut hole, also may vary from plan to plan.

"The task consumers face will be quite challenging," said Mr. Hoadley, the Georgetown University researcher. "Because nearly every plan has a unique plan design, even researchers like myself find it challenging to sort out the choices."

Deane Beebe, a spokeswoman for the Medicare Rights Center, added: "There's a lot of fine print that people need to find out about before they sign up for a plan."

Before they take the trouble, though, Medicare recipients should ask themselves whether they even need Part D coverage.

In Pennsylvania, many already have good drug coverage through their veterans or retiree benefits. If they have coverage at least as good as Part D -- coverage known as "creditable" -- they might be better off without the new federal program.

People in PACE and PACENET, the state's drug assistance programs, also have creditable coverage. Consumer advocates advise them to remain in those programs, though some may pay less for prescription drugs if they also join a Part D plan and qualify for subsidies to help cover their costs of being in the program.

Certain drug coverage, including that which is provided through most Medigap plans that supplement Medicare coverage, likely will not be considered creditable, so these consumers might want to consider joining a Part D plan.

Medicare recipients with drug coverage should be receiving letters from their plans indicating whether they have creditable coverage. They also can call the plans and ask.

Medicare recipients who do not have creditable coverage should determine whether they qualify for PACE or PACENET before signing up for Part D, said Jack Vogelsong, coordinator for the state's Apprise program, which provides free health insurance information to seniors. Individuals may qualify if their annual incomes do not exceed $23,500, and married couples if their incomes do not exceed $31,500.

Another group, Medicare recipients who also receive Medicaid, will automatically receive Part D coverage, generally at minimal cost to them. Drug coverage for those recipients, known as dual eligibles, will move from Medicaid on Jan. 1. If they do not choose a plan, they will be automatically enrolled in a Medicare Advantage plan or a standalone plan.

Medicare recipients whose incomes are too great to qualify for the state assistance programs and who lack creditable coverage may want to consider choosing a Part D plan.

Sign up or pay more later
While Medicare beneficiaries do not have to sign up, failing to do so may have financial consequences.

If they lack creditable coverage, the penalty for not signing up during the initial enrollment period is a higher monthly premium if they ever decide to enroll. The extra charge -- 1 percent of the average monthly premium for every month they delayed -- continues for as long as they're enrolled in the Medicare drug program.

Medicare recipients without creditable coverage who do not sign up by May 15 would pay a 7 percent penalty if they joined during the next enrollment period, which begins Nov. 15, 2006.

Those interested in enrolling in a Part D plan should first decide if they want a standalone plan that provides only drug coverage, or a plan that covers drugs and medical care. Many Medicare Advantage plans are offering Part D coverage and medical care, though access to a wide range of doctors and hospitals is generally more limited than through traditional Medicare.

Participants enrolling in a Medicare Advantage plan need to determine not only that their drugs and pharmacies are covered under the plan, but also that their doctors and hospitals are participating.

Two of the Medicare Advantage options available locally are private fee-for-service plans, which operate like traditional Medicare but are administered by private plans. This type of plan has been around for several years, but has not been popular here, and should be approached with caution, said Mr. Vogelsong, the Apprise coordinator.

"Essentially, fee-for-service plans will pay doctors and hospitals what the Medicare program pays," he said. "But the beneficiary must make sure that the provider is willing to send the bill to that private fee for service plan."

If the provider won't, the beneficiary might be put at financial risk, Mr. Vogelsong said.

A few Medicare Advantage plans in the Pittsburgh area do not offer Part D coverage. Members of those plans will need to choose a standalone plan if they want drug coverage through the new federal program.

Take deep breath and study
With all the complexity, is choosing a plan an impossible task?

Not necessarily, experts say.

Slow down and take the time to study the issue thoroughly, Mr. Vogelsong recommends. Don't buy a plan the first time you look at it -- and tell plan representatives you'll get back to them.

Once they've decided on the type of plan they want, Medicare recipients need to compare the drug benefits among plans. They can narrow down their choices based on their needs.

Those who take few drugs may want to look for plans with low-cost monthly premiums. While those plans may have restrictions, people who use few drugs probably won't be affected, said Ray Landis, associate state director for advocacy for AARP Pennsylvania.

For those who take more drugs, but maybe no more than $2,250 worth in a year -- the typical threshold of the doughnut hole -- they should weigh not only the cost of premiums, but also of copays and deductibles.

Those who take many drugs may also want to compare discounted prices among the plans as well as mechanisms that could limit access to medications.

The other two 'Cs'
Cost, of course, is just one of the "three Cs" that Medicare beneficiaries should consider, said Barbara Dickman, a local volunteer with AARP and Apprise. Convenience and coverage are the other two factors, she said.

Convenience refers to whether a plan includes pharmacies that are near a beneficiary's home.

Coverage refers to whether a plan covers the drugs the beneficiary is using.

"The easiest way to investigate this is to get your drugs lined up in front of you, call 1-800-Medicare (633-4227) -- if you can get through," Mrs. Dickman said. "If you can't get through, call the Apprise people. Either way, they'll tell you which of the two or three or four plans in your area will be advantageous to you."

Comparing plans in detail, however, can be difficult.

While Medicare has a great deal of information available on its Web site, www.medicare.gov, much information is lacking to help consumers make comparisons, Mr. Hoadley said.

Medicare is developing a "formulary finder" and "plan finder" on its Web site that would allow consumers to enter personalized information, including medications and preferred pharmacies, to help them find plans that best meet their needs. Those resources should be available by Nov. 15, said Peter Ashkenaz, a spokesman for the Centers for Medicare and Medicaid Services.

Medicare recipients also can contact the plans and ask, for example, whether their drugs and pharmacies are covered. But "people often aren't given clear information," said Fran Chervenak, managing attorney for the Pittsburgh office of the Pennsylvania Health Law Project. "I hear that time and time again."

Recipients should be able to contact the plans or visit their Web sites to obtain a Summary of Benefits, a document that outlines the plan's features.

They also can ask for a list of pharmacies participating in the plan, and a formulary that lists the drugs covered by the plan and indicates whether prior authorization or other measures are required to obtain certain drugs. Even if some drugs are not included on a plan's formulary, doctors can request that exceptions be made.

Covered drugs can change, though people taking drugs that will no longer be covered must be notified.

Mr. Vogelsong said trying out a plan might be the best way to know if it is a good fit. He noted that most participants will be given at least one opportunity to change to another plan before May 15.

He predicted that access to drugs will not be a significant problem, at least early on.

"There is a tremendous amount of pressure to make this program work," he said, noting that a high number of complaints would make the program "a political failure."

"Down the road, once that pressure is perhaps gone or the cost of a program is perhaps higher than what was expected, then I think we need to be a little more concerned."