Starting Saturday, virtually all Idahoans age 65 or older have the chance to decide which insurer has the best deal for prescription drug coverage.

It's likely the most important decision seniors make on their Medicare coverage. Seniors who already have coverage and fail to make a new choice by Dec. 31 will be automatically re-enrolled in their current plan, even if it's no longer the best fit. Plans can, and often do, change.

And the choices can be daunting. There are roughly 50 prescription drug policies, known as Medicare Part D, available in the Treasure Valley. One other kind of coverage, called Medicare Advantage, may also cover drugs. About 20 Medicare Advantage plans are available here.

Because the choice is so crucial, we have developed a question and answer guide.

But keep this in mind: Medicare is big and complex. Every answer uncovers new questions, and there are no one-size-fits-all answers. We're offering basic guidelines and resources for more detailed help.

Q. DON'T SENIORS GET MEDICARE AUTOMATICALLY AT RETIREMENT?

A: Seniors must apply for hospital and doctor coverage when they turn 65. There is no monthly fee, or premium, for hospital coverage if seniors or their spouses have worked 10 years. However, seniors must contribute a small amount for the care they get. That's called a deductible.

The doctor coverage costs a $96.40 premium each month, and seniors also must pay a $135 deductible annually. There are penalties for retirees who wait until they are ill to sign up.

Q. WHAT AM I SIGNING UP FOR NOW?

A: Either Medicare Part D, which is the prescription drug policy, or Medicare Advantage, which is a medical policy that replaces Part D and which can, but doesn't always, cover prescription drugs.

Enrollment for Medicare Part D and Medicare Advantage is Nov. 15 to Dec. 31. Seniors who want to switch Advantage plans may do so from Jan. 1 to March 31.

Q. WHY DO SENIORS NEED DRUG COVERAGE?

A: Because if you stop at basic, government-issue hospital and doctor coverage, you won't have any help paying for prescription drugs, which cost seniors an average of $2,000 or more a year.

Some seniors neglect to sign up for coverage when they are eligible at age 65 because they feel they don't need it. But if you wait to sign up until you are sick and need medicine, you will pay extra for putting it off. The penalty is 1 percent a month for every month you didn't sign up when you were eligible for drug coverage. The penalty is intended to keep people from abusing the system.

The only exception is seniors who have employer-based or other coverage that is as good as or better than Medicare plans. Talk to your employer or other source of coverage to be certain.

You can choose Medicare Part D, which is the prescription drug policy, or Medicare Advantage, which replaces your government-issued Medicare policy. Medicare Advantage plans often cover prescription drugs.

Q: IS THERE A WAY TO REDUCE THE AMOUNT I HAVE TO PAY FOR PREMIUMS, DEDUCTIBLES AND COINSURANCE?

A: Yes, and it's called Medigap, which is private coverage that fills in the gaps of what Medicare does not pay for, usually deductibles and co-pays. Medigap does not, however, pay for prescription drugs.

Q: HOW MUCH DO PRESCRIPTION DRUG PLANS COST?

A: In 2009, the average monthly premium for drug coverage nationwide will be $45.45. That is a 14 percent increase, according to the Kaiser Family Foundation, a nonprofit health research group headquartered in California.

Policies also may have varying deductibles, copayments or coinsurance, and a coverage gap, sometimes called the "doughnut hole," during which seniors generally have to pay the entire cost of their medicine.

In Idaho, prescription drug plans will range from a low of $18.50 a month to a high of $113.70 a month. That range is broader than in almost any other state. Only Utah has the same price range.

Donna Denney, spokeswoman for the Idaho Commission on Aging and the state's Medicare education program coordinator, did an informal comparison of Idaho prices in 2008 and 2009.

She found six policies that will cost less in 2009, although most of the reductions are modest. The rest increased, from 40 cents a month to $40 a month.

Medicare Advantage plans, some of which include prescription coverage, will have premiums ranging from zero to $123 in Ada County in 2009.

Q: CAN LOW-INCOME SENIORS GET HELP PAYING THEIR MEDICARE BILLS?

A: Yes. In 2008, single seniors qualified for extra help if their yearly income was less than $15,600 and they had certain financial assets worth less than $11,990. Those numbers may change in 2009.

Q: WHAT IS THE BEST POLICY?

A: Sorry, there is no simple answer. It depends on what you want or need.

However, in general, it's the policy that covers as much of the medications you take as possible at the lowest possible price. The very best policy for one person may be the worst for another. The policies do not pay for the same drugs and have different premiums.

Q: HOW DO I FIND THE BEST POLICY ON MY OWN?

A: You have to start with a computer. You cannot sign up on your own using paper forms. If you don't have a computer, get help from a family member or go to a senior center.

The online tool is at Medicare.gov, which Idaho officials call an amazing example of what the government can do right.

Follow the step-by-step instructions. By doing so, you will create a list based on your medications, price or other criteria you choose. Medicare.gov includes telephone numbers and Web sites to contact companies that interest you.

Seniors also will learn if their income and assets may qualify them for special help paying for their care. To learn more, dial 211 from anywhere in Idaho to find the nearest center offering help.

Q: THIS SOUNDS LIKE A LOT FOR ME TO DO. HOW LONG DOES IT TAKE?

A: Volunteers who sign up seniors for Medicare drug plans or Advantage plans say it takes one to two hours for them to complete the process.

Q: WHERE CAN I GET HELP CHOOSING?

A: Many people have questions about definitions of words and other issues involving their particular Medicare coverage. Idaho has more than 120 volunteers across the state providing seniors with one-on-one help using Medicare.gov.

For senior health insurance information, counseling and assistance or to discuss volunteer opportunities, call toll free within Idaho: 1-800-247-4422.

Make that call now. Some Boise volunteers are already booked into mid-December.

Q: HOW DO I KNOW IF THE PLAN I CHOOSE HAS HAD PROBLEMS?

A: Medicare.gov will show you the rating of the plans based on customer complaints. The best plans get a five-star rating, for example.

Q: SO, I STILL HAVE QUESTIONS. WHOM DO I CALL?

A: Again, call Idaho CareLine at 211 or 1-800-247-4422, or go on the Internet at Medicare.gov.

Sources: Beth Shell, 67, of Boise, a volunteer who helps seniors pick the best plans for their needs; Donna Denney, spokeswoman for the Idaho Commission on Aging and the state's Medicare education program coordinator; Genii Hamilton, SHIBA insurance advisory specialist, Idaho Department of Insurance; Centers for Medicare and Medicaid Services.

Colleen LaMay: 377-6448