When the new enrollment period for the Medicare prescription drug program begins Thursday, local residents interested in the coverage will have more choices than ever.

In Allegheny County alone, most Medicare recipients will have until Dec. 31 to evaluate about 96 private plans offering drug coverage for 2008, seven more plans than this year.

That's not counting another 10 plans available for people who also qualify for Medicaid or have other special needs, up from four plans in 2007.

Not all Medicare recipients need to consider the dizzying array of choices.

Recipients who already have good drug coverage -- for example, through a retiree health plan -- may not need to enroll in the Medicare drug program, known as Part D. And if they don't choose a plan, some people who receive both Medicare and Medicaid, known as dual eligibles, and others in the state's drug assistance programs, PACE and PACENET, are automatically enrolled.

Dual eligibles also have flexibility to change their Part D coverage after Dec. 31.

But for many Medicare recipients, failing to enroll in a Medicare drug plan by the end of the year could have consequences. Some recipients who are eligible but don't sign up now could pay higher premiums if they ever decide to enroll.

Medicare recipients already in Part D plans often can stay in them for another year. But consumer advocates strongly recommend that beneficiaries compare plans, noting their medication needs and plan details may have changed.

One change that caught the eye of Richard Daley was his plan's monthly premium, which will increase next year by about one-third.

Mr. Daley, of West Homestead, questioned why the premium for his plan, UPMC for Life HMO Rx Enhanced, is going up to $97, from the current $72.50.

"I don't think it's fair," he said, noting that the health plan's parent, the University of Pittsburgh Medical Center, has reported record profits.

Kathy Batteer, the health plan's vice president for Medicare, said people in the Enhanced plan tend to use more prescription drugs than people in some other plans.

"If we look at the historical performance of the product, it requires a higher premium," she said.

Mr. Daley, 65, said he will likely stay with the plan despite the increase. Though he does not regularly take prescription drugs now, he noted that his health care needs could change.

He is in a Medicare Advantage plan providing both medical and drug benefits, and much of the local growth in plan offerings next year will occur in those plans.

In Allegheny County, about 33 Medicare Advantage plans will be offered with drug coverage, not counting the special needs plans, up from 20 this year. Still other Medicare Advantage plans are available that do not offer drug coverage.

The number of "standalone" Medicare plans offering only drug benefits, by contrast, will drop from 69 to 63.

Similar trends are occurring nationally, said Abby Block, director of the center for beneficiary choices at the federal Centers for Medicare and Medicaid Services.

Fran Chervenak, manager of the Pittsburgh office of the Pennsylvania Health Law Project, said companies have a financial incentive to offer Medicare Advantage plans. Critics have suggested that federal subsidies to those plans should be reduced.

If that occurs, "it will be hard, if not impossible, for Medicare Advantage plans to offer the benefits they do today," Ms. Batteer said.

Ms. Block said the growth in the number of those plans is due in part to companies expanding into rural areas and adding to their plan offerings.

In Allegheny County, for example, Highmark is making nine Medicare Advantage plans with Part D coverage available to most recipients in 2008, up from four this year.

Cynthia Dellecker, Highmark's senior vice president of senior products, said the plans represent the company's effort to address a broad array of needs.

Added to its SecurityBlue Standard and Deluxe plans, for example, is a new Basic plan that has a higher hospital copay and annual maximum, but a lower monthly premium.

Monthly premiums for the Standard and Deluxe plans will increase by about $10 each, but copays for generic drugs will be lower.

Highmark also is offering two private fee-for-service plans with drug coverage that were not available this year. Ms. Dellecker said the plans offer more options because, unlike the other plans, they do not require patients to use doctors and hospitals in a specified network.

Hospitals and doctors don't necessarily accept those plans, however. Consumer advocates strongly suggest that Medicare recipients check with the facilities and medical professionals they plan to use before they sign up.

In Allegheny County, Unison Advantage is still offering two Medicare Advantage plans next year, Choice and Preferred, though there will be changes. The Preferred plan's monthly premium and hospital copay will be lower. Both plans offer coverage of dentures and some other dental services.

Monthly premiums for HealthAmerica's Bronze and Silver Advantra plans will remain unchanged, with a slight increase for the Gold plan. The company also is offering a new private fee-for-service plan.

Locally, another new feature this year is the appearance of special needs health plans that don't specifically target people who receive both Medicare and Medicaid. HealthAmerica, for example, is offering the plans for people with diabetes and high cholesterol.

Among other benefits, the diabetes plan offers a lower copay for some blood sugar testing supplies and a zero copay for certain diabetes drugs, even through a coverage gap known as the doughnut hole.

Nationally, the number of special needs plans is increasing next year by 58 percent, Ms. Block said, primarily because of an increase in plans for people with chronic care needs.

She said the increase may be due to a change in the formula used to pay companies that takes into account a patient's health status.

Ms. Block said it is unclear if such plans will provide improved benefits, "though that's something we're trying very hard to measure."

With changes to existing plans and so many plans to choose from, experts suggest that Medicare recipients, either on their own or with help from others, visit www.medicare.gov. Information on the Web site is available to help recipients compare plans in their area, though consumer advocates recommend that recipients confirm details by calling plans directly. Telephone numbers for the plans and other information, such as monthly premiums, are listed on the Web site.

Other help is available by calling 1-800-MEDICARE (1-800-633-4227) and from a number of other sources.

Apprise, the state's free health insurance counseling program for Medicare recipients, can be reached at 1-800-783-7067. In a change from last year, Apprise services in Allegheny County are being provided through Family Services of Western Pennsylvania, 412-661-1438.

For dual eligibles and other low-income people who qualify for federal subsidies to enroll in Part D, help is available from the Pennsylvania Health Law Project, 1-800-274-3258 or www.phlp.org.

For information on the state's drug assistance programs, PACE and PACENET, which serve people with low incomes, call 1-800-225-7223.

The Medicare Rights Center also operates a toll-free hotline, 1-800-333-4114.