WASHINGTON — Sales pitches at senior centers. Annoying marketing calls at the dinner hour and free gifts for attending promotional events.

Beginning today, private insurers offering Medicare prescription-drug coverage will roll out a dizzying array of radio, television and print ads to promote their policies.

Look for mailboxes bulging with fliers, displays at local pharmacies and confused looks on the faces of older Americans trying to figure out which plan is right for them.

Consumer advocates are offering advice on making a decision.

As a result of legislation passed in late 2003, Medicare will, for the first time in its 40-year history, provide outpatient prescription-drug benefits as of Jan. 1, 2006.

More than 30 million people are expected to get the drug coverage, which is provided by private insurers on behalf of Medicare. Those insurers want to sign up as many plan members as possible when open enrollment begins Nov. 15. Everyone on Medicare is eligible for the drug benefit, including people with disabilities.

Information

About the drug benefit: Call 800-MEDICARE

Or visit www.medicare.gov/medicarereform/drugbenefit.asp

For plan offerings in Washington state: www.cms.hhs.gov/map/map.asp

Center for Medicare Advocacy: www.medicareadvocacy.org

To help senior citizens, Medicare will launch a Web site in mid-October that picks appropriate drug plans based on the medications people take and the pharmacies they prefer.

Plans that recruit the most new members are more likely to get a mix of healthy and sick patients, which is crucial in balancing the cost of coverage, said Brad Ellis, an insurance-ratings group director at Fitch Ratings of Chicago. Healthy enrollees who use fewer drugs offset the cost of sicker patients who use more.

"You want to get as many people into the program as you can to help spread the risk," Ellis said.

The new rules

Cost, convenience and coverage should be the main considerations when choosing a plan, said Hilary Dalin, Medicare coordinator for the Health Assistance Partnership in Washington, an umbrella group for consumer-health programs. She offered a few tips to help make the plan selection easier:

• Cost: Monthly premiums will vary greatly among the plans, ranging from low or no premiums to some that could top $35 a month. While cost is important, lower premiums often require you to share more of the costs or they cover a more-limited selection of drugs. Be sure to check what you get for your money. "Just the fact that there isn't a premium shouldn't be the end of the inquiry," Dalin said.

• Convenience: For many seniors, the biggest question about a plan is "Can I keep going to my regular pharmacist?" But be sure to ask specifically, "Is my regular pharmacy in the plan's network?" If so, is it a "preferred pharmacy" or a "nonpreferred pharmacy"? Preferred pharmacies offer greater discounts.

• Coverage: Make sure to ask these basic questions. Are the drugs I take on the plan's formulary? Under what conditions are they covered? Do I have to get prior approval from the plan to have drugs paid for? Will the plan require me to see whether a generic medication works as well as a brand-name medication the doctor prescribes?

Ask how the plan handles situations in which a doctor prescribes a drug that isn't covered but is the only one you can take. Find out what happens when a plan does cover a particular drug but not in the dosage that you take.

Remember that plan members can switch coverage only once a year, but the plans can change the drugs they cover after giving 60 days' notice to Medicare, their network pharmacies and the patients who take the medications, Dalin said. Plans also can increase prices for their drugs by following the same procedure.

To avoid some of the fraudulent marketing that occurred with the Medicare prescription-drug cards last year, Medicare met with drug-plan representatives recently to make sure they understood the rules. Law enforcement and local consumer-protection agencies will also be watching for reports of fraudulent activity, Medicare administrator Mark McClellan said.

The agency has hired private firms to help it police the activity and will fine and penalize violators. McClellan said the drug plans also would help identify bad players among them.

"If they're following the rules, they don't want to see other companies get away with bending or breaking them," McClellan said yesterday. "We're gonna be on top of this."

In ads, a company can say it's contracting with the federal government to offer coverage, but it can't say "Medicare endorses" or "wants you to join" its plan. It also can't use doctors or other health-care workers to urge people to enroll in a certain plan.

Companies can use Medicare beneficiaries for testimonials, but they can't use actors posing as Medicare beneficiaries. If companies pay a beneficiary to appear in a testimonial, they must make the financial arrangement clear in the ad, Dalin said. In addition, plans can't use negative testimonials to criticize other plans.

They also can't offer or give money to induce a referral of someone into a plan. "Not even if it's a charitable contribution," Dalin said. They can give a nominal gift — no more than $15 in value — to those who attend promotional events, but only if the gifts are given to everyone in attendance and with no other obligations.

Plans are allowed to do presentations and distribute literature in common areas of health-care settings, such as a conference room at a hospital or nursing home. "But it can't take place in a doctor's waiting rooms, exam rooms or at a pharmacy counter," Dalin said.

Health-care providers also have constraints. Doctors, pharmacists, nursing-home administrators and hospital managers can give the names of plans in which they participate, but they can't say which plan a person should join.

Material from The Seattle Times archives is included in this report.