The ABCs of Medicare Part D

The sign-up period for a massive federal program to help older and disabled Americans pay for prescription drugs ends Monday, and it remains as controversial as ever.

In December 2003, the Medicare Modernization Act created Medicare Part D, a drug benefit that immediately drew fire from both the left and right. While some touted it as landmark legislation to address a growing and urgent need, it was also called a windfall for drugmakers and insurers, a budgetbuster, and a nightmarish journey into a complex world of benefit plans for seniors. The benefit took effect Jan. 1.

After a shaky start last November, the sign-up process seems to have gone more smoothly lately. Those eligible for Medicare who don't sign up for Part D by Monday and want coverage in the future will pay higher premiums - unless they qualify for a low-income exemption or have what is called "creditable" coverage through another source, such as a retirement plan.

In recent weeks, President Bush and other Republican leaders have begun to characterize the program as a great success. "The Medicare Part D Prescription Drug Plan is a win-win for American seniors," House Speaker Dennis Hastert (R) said last week. "Today more than 30 million seniors recognize that and have enrolled in this plan that will help them get much-needed prescription drugs at a lower cost than was originally estimated."

But critics say the program falls far short both in concept and execution. "The Bush administration has left behind the neediest Americans, the men and women who were supposed to benefit most from drug coverage," said Robert Hayes, president of the Medicare Rights Center, a healthcare advocacy group in New York.

As the program marks a major milestone Monday, here are answers to some of the most common questions about it:

The administration says that by the end of the sign-up period Monday, it expects nearly 90 percent of the roughly 42.5 million Americans eligible for Medicare Part D to have some kind of drug coverage. It also estimates that the average beneficiary will save more than $1,100 this year alone. About 9 million people signed up on their own. Others were moved from prior drug programs, were automatically signed up by their insurers, or have equivalent coverage through retirement programs.

But critics say the government's coverage numbers have been manipulated and are far too optimistic. "[B]y our conservative analysis, about 10 million older adults and disabled Americans still lack drug coverage," Mr. Hayes says.

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