If you're a senior enrolled in a Medicare prescription drug plan, you could see a sharp increase in the cost of that coverage beginning in January.

Data from the federal Centers for Medicare & Medicaid Services show that approximately 85,000 New Hampshire residents are currently enrolled in Medicare prescription drug plans -- including some plans that will no longer be offered next year.

And according to the CMS, 36 of the 46 drug plans that will be available in New Hampshire in 2009 will be raising their monthly premiums. Those increases range from a few cents for some plans to nearly $20 for others.

Subscribers of Humana Insurance Company's "Standard" plan, for instance, will see their monthly premiums jump from $19.60 to $39.20 a month. Certain "premier" plans offered by Aetna and AARP insurance programs will also jump by about $20 a month.

And there are other changes, as well. Some companies are raising deductibles, changing the medications they cover, or changing what they cover during the so-called "gap" period before catastrophic coverage kicks in.

Seniors have until the end of the year to join or switch prescription drug plans. The annual open enrollment period for the Medicare "Part D" program began yesterday for coverage that begins Jan. 1st.

Now's time to research

Advocates say this is a good time for anyone enrolled in a plan to find out if their coverage and costs are changing.

Kim Hadank-Swinson, Medicare/Medicaid program specialist at the state Department of Health and Human Services, said she is particularly concerned that many plans are dropping their zero-premium discounts for low-income subscribers next year.

There were 18 plans that offered a zero monthly premium for the lowest-income folks here in 2008; next year, just five plans will do so.

That means some low-income seniors who are currently paying no monthly premiums could end up paying anywhere from $1.90 to $21.60 a month if they keep their old plans.

According to CMS, 28 percent of New Hampshire seniors enrolled in prescription drug plans receive the low-income subsidy.

And given the economic downturn, there may be even more folks who now qualify for that discount, Hadank-Swinson said.

She points out that when there are more low-cost plans available, seniors have a better chance of finding one that covers their medications. She's also concerned that the co-pays in many plans are going up next year, even for those with discounted premiums.

"The hard part for me is the whole objective with putting the Part D Medicare prescription drug coverage . . . under private insurance companies, is that the competition was supposed to keep the prices lower," she said. "And what I've seen so far is the premium prices, as well as the costs, seem to keep increasing for people with Medicaid and Medicare."

Low-income options

So what happens if you're in a plan that no longer offers the low-income subsidy (LIS) for which you are qualified? It gets complicated:

-- If you signed up for a plan yourself, you'll need to switch to one of the five plans that do offer the discount if you want to avoid paying premiums.

-- If you were a dual recipient of Medicare and Medicaid when the Part D program was created, the federal government randomly assigned you to one of the plans available at the time. If that plan no longer provides the LIS, you'll be automatically switched to a plan that does.

-- However, many seniors who were automatically assigned to plans discovered their medications weren't covered by those plans and chose to switch to other plans. If you're one of these, you won't automatically be switched; if your plan no longer offers the discount, you'll need to switch to a new plan that does.

Hadank-Swinson noted Part D plans also change their "formularies," the lists of brand and generic drugs covered at different co-payment tiers each year. That's why she advises anyone in a prescription drug plan to make sure their medications will still be covered next year.

Where to get answers

So how can seniors sort through the changes and figure out whether they want to keep their current plan or enroll in a new one?

That's where ServiceLink comes in. The agency has a staff of counselors across the state who can help seniors figure out whether they need to change their prescription plans -- and the service is free of charge.

Anita Oelfke is the Medicare services coordinator at ServiceLink for Merrimack County; she's been involved in educating seniors about the Part D program since it was first created by Congress in 2003.

Oelfke said her agency has been getting calls from seniors who have seen their premiums go up.

Another concern is a decrease in the number of lower-cost plans with no deductibles.

"Last year we had better than half with no deductibles, and a number of them were in the mid-range and the less expensive plans," Oelfke said.

But for next year, "the problem is the ones with no deductibles have a higher premium, so we're going to have fewer people who can really afford them," she said.

Source of confusion

Everyone enrolled in a Part D plan should have received a federally-required notice of any changes in the plan. But Hadank-Swinson worries that some folks may have difficulty understanding the often-complex information.

Seniors are bombarded with advertising from various drug plans, as well as mailings from federal programs such as Social Security and Medicare, Oelfke said. "And it makes it really difficult to decide what they really need to pay attention to and what's just advertising," she said.

Oelfke advises seniors who are not Internet savvy to ask friends or family members to help them research the various plans on the medicare.gov Web site, or to call a ServiceLink counselor to help figure out if their plan is still the best for them.

"Even if you're happy with it, it's always good to know what your options are," she said. "And because they restructure every year, it's always a good idea to at least get a review and see."

Navigating the federal Web site can be challenging, Oelfke said.

She noted a study conducted at Cornell University asked second-year doctoral students in pharmacology to find the three least-expensive plans based on a simulated set of medications.

"Only 46 percent of them were able to do so," she said.