There's one question that people ask more often than any other whenever Larry Grimaldi, of the state Department of Elderly Affairs, addresses Medicare beneficiaries about the new drug benefit.

And it's the one question that Grimaldi can't answer:

Which plan is best for me?

There are 173,000 Medicare beneficiaries in Rhode Island, and Grimaldi says there may well be 173,000 different answers to that question.

That is part of what is making this vast change in Medicare so difficult for beneficiaries: There is no single, easy choice -- no Consumer Reports-type rating to guide you. What's best for your neighbor may not work for you. And figuring out what works for you requires many steps.

On Tuesday, Medicare beneficiaries can start enrolling in the new drug program known as Medicare Part D. But you don't have to make a decision then -- you have till May 15 to sign up.

Here are answers to some common questions concerning this choice.

Q:

I'm so confused by all these options. Where do I begin?

A:

Dr. Charlotte S. Yeh, Boston regional administrator of the U.S. Department of Health and Human Services, says the first step is to assess your current situation. Find and write down the answers to these questions:

1. Do you have drug coverage now? If so, who provides it and what does it cost?

2. What drugs do you take? How much do you spend on them?

3. Which pharmacies do you use?

Along with these answers, gather up any information that has been sent to you concerning Medicare, and put it in one folder.

Then, decide what process you'd like to use to make your decision. You could ask for a one-on-one meeting with a volunteer trained to help you, by calling the state Senior Health Insurance Program, at (401) 462-3000.

You can get advice from Medicare on the phone, by calling 1-800-MEDICARE (1-800-633-2273), but you will have to use an automated voice system with a menu of options before you reach a live person.

If you're comfortable using the Internet, or can work with someone who is, you can go to http://www.medicare.gov and click on the line that says "Compare Medicare prescription drug plans." This takes you to the Medicare Prescription Drug Plan Finder. You enter the number on your Medicare card, answer various questions about your needs and preferences, and the computer will come up with a list of plans that meet your personal criteria.

Q:

What factors do I need to consider in making this choice?

A:

You need to consider how much each plan costs, what drugs the plan covers, and whether it covers the pharmacies you use, including mail-order or out-of-state pharmacies.

These are the costs you will face:

The monthly premium, which in Rhode Island ranges from $7.32 to $65.58. The Medicare & You Handbook mailed to you last month lists all the plans in Rhode Island and their premiums.

The deductible, which is the amount of money you have to spend on drugs before your benefit kicks in. The deductible cannot exceed $250. Twenty-eight of the plans in Rhode Island have no deductible, and three have deductibles below $250.

Your copayments. That is your share of each drug's cost, the money you will have to pay your pharmacy when you pick up your prescription. This amount cannot exceed 25 percent of the drug's cost, but many of the plans will be charging less. To figure out what your copayments will be, you need to find out how much each of your drugs will cost under each plan, and what percentage of that cost you're expected to pay.

The coverage gap or "doughnut hole." After you have spent $2,250 on drugs, you will have to pay 100 percent of your drug costs until you've spent a total of $3,600. Then you're covered again, for 95 percent of drug costs. Some plans, however, offer coverage for generic drugs during this gap. If you have high drug costs, you might want to consider such a plan.

Q:

Do I have to enroll in Part D?

A:

No, the plan is optional. But don't let it slip by without considering its value. You could save a lot of money by enrolling. If you fail to sign up by May 15, but decide later you'd like to enroll, the drug coverage will cost you significantly more than if you sign up before that date.

You won't be subject to that penalty if you're enrolled in a plan that the federal government has determined is equal to or better than Part D. These plans are called "creditable" plans. Such plans know who they are, and are supposed to inform you before Tuesday.

Q:

I already have drug coverage. Do I need Part D?

A:

It depends on what kind of coverage you have. If you're retired and have private insurance coverage through your former employer, you need to find out whether your retiree coverage is "creditable" -- at least as good as Medicare Part D. By Nov. 15, the employer should send you a letter stating whether its plan is creditable. As long as you have creditable coverage, you won't be subject to any penalties if you decided to enroll in Part D after May 15, 2006.

Q:

Although I'm eligible for Medicare, my wife is still working and I'm covered through her Blue Cross plan. Do I need to enroll in Part D?

A:

You need to find out from the company that sponsors your wife's coverage whether her plan is "creditable" -- as good as or better than Medicare Part D. If so, get a letter stating that -- and put it in a safe place. You can stick with your wife's plan if you wish. If your wife retires or you decide later that you'd prefer Part D, you won't be penalized for signing up late, as long as you can produce that letter stating that your plan was "creditable."

Q:

I get drug coverage through a Medigap policy. Can I keep it?

A:

You can keep your Medigap policy -- but after Jan. 1, it will no longer cover drugs. So you should definitely choose a Part D plan if you want to have prescription-drug coverage. You can have both a Medigap policy and a Part D plan. Contact your Medigap insurer for details.

Q:

I currently get my drugs covered from the VA. Should I consider Part D?

A:

No. You can relax. If you get your drugs through the Veterans Administration, stick with that. You don't have to do anything.

Q:

I'm on both Medicaid and Medicare. Medicaid has been paying for all my drugs. Now what happens?

A:

You will be automatically enrolled in a Part D Medicare plan. If you don't like the plan Medicare chooses for you, you can switch at any time. You will not have to pay a premium or a deductible, and you will have no coverage gap. This is true for people who are elderly and low-income, and for people who have disabilities. This includes disabled children on Medicaid. The same rules apply to anyone who is enrolled in both Medicare and Medicaid.

But one important thing will change for Medicaid-Medicare beneficiaries in Rhode Island: The beneficiary is going to have to pay a share of each drug's cost. When you pick up your prescription at the pharmacy, you will have to pay $2 for a generic drug or $5 for a brand-name drug.

Q:

I'm enrolled in RIPAE (Rhode Island Pharmaceutical Assistance for the Elderly). Should I consider Part D?

A:

Absolutely. RIPAE, a state program that subsidizes certain drugs for low-income people, is not "creditable," meaning it's not comparable to Part D. It is no substitute for Part D. If you are low-income and qualify for extra help from the federal government, you are required to apply for that help and use it before you use your RIPAE benefit.

But RIPAE enrollees are encouraged to renew their RIPAE membership even after they've signed up for Part D. They can use their RIPAE card for discounts on telephone and cable service and free admission to state beaches. And RIPAE will subsidize drugs not covered under Part D, including drugs you buy before you use up your deductible and during the coverage gap.

Q:

My drug costs are lower than the Part D premiums. Why should I bother with Part D?

A:

Because you may need more drugs in the future. Part D is an insurance program.

"We don't wait for our house to burn down before we buy homeowner's insurance," says Yeh, of Health and Human Services. "I'm an emergency physician. I practiced about 20 years. I have treated lots of people who were healthy one day, and the next day something happened. Suddenly they're on five, six, seven, eight medications."

If you don't sign up by May 15, 2006, and a day comes when you suddenly need costly medications, you won't be eligible for Part D coverage until Jan. 1 of the following year. Then, if you sign up, you'll have to pay a significant surcharge on your premium; your premiums will increase by at least 1 percent per month for each month that you waited to sign up. So the longer you wait, the greater the penalty.

Some people may have enough confidence in their health, or enough money in the bank, to take the risk. But officials hope not too many. Like any insurance program, Medicare Part D needs a certain percentage of healthy people on the rolls -- people who pay more in premiums than they spend in benefits.

Q:

I'll never figure this out by Tuesday.

A:

You don't have to. Tuesday is just the beginning. You can enroll as late as Dec. 31, and still have your coverage start Jan. 1. If you can't decide before Jan. 1, you still have till May 15 to avoid the penalty, and have your coverage start the first day of the next month.

"Nobody's getting any prizes for being first," says Grimaldi, of Elderly Affairs. "We want you to make the best choice."

Still have questions? The Journal will continue to cover this issue in the coming weeks and will answer as many questions as possible. Call (401) 277-7400 and leave us a message, or send an e-mail to medicare [at] projo.com. We cannot answer every question in the paper, nor can we give personal responses.