Medicare beneficiaries are not enthused about the program's new prescription drug benefit, which begins enrolling its first participants Tuesday.

A survey of older people finds them divided into three camps:
_37 percent view the program unfavorably.
_31 percent have a favorable opinion.
_31 percent said they just do not know enough about the benefit to have an opinion.

"Seniors still are having a hard time. Seniors still aren't really prepared, and they're going to need a lot of help to make the choices they need to make under the law," said Dr. Drew Altman, president of the Kaiser Family Foundation, which undertook the survey with the Harvard School of Public Health.
The foundation conducts health research and has no affiliation with any company providing prescription drug coverage through Medicare.

Many beneficiaries already have drug coverage. That factor was listed as the No. 1 reason why people would not be enrolling in a private plan this year.
"When you look at the people who say they don't plan to enroll, it's mainly because they already have coverage. They have coverage through a former employer or through a Medicare health plan, and that's just great," said Mark McClellan, administrator for the Centers for Medicare and Medicaid Services.
Among those surveyed who said they lacked drug coverage, only 28 percent said they would enroll. Twenty-three percent said they would not and 49 percent did not know.

"It depends a little bit upon which survey you see," McClellan said. "I can get five other numbers from other places that show a lot of interest in enrolling among people who don't have coverage now."

The survey, taken through telephone interviews of 802 respondents Oct. 13-31, has a margin of sampling error of plus or minus 3.5 percentage points.
Altman said it will take a year or so to get a sense of what beneficiaries think about the law.

"It's just too complicated for them to get it from a brochure, or a Web site, or to answer the critical question of, 'What does this mean for me?'" Altman said. 

"Unfortunately, it's going to take a real world test for us to figure out whether this works or doesn't work."

John Rother, director of policy and strategy at AARP, said he is not surprised that people have yet to warm up to the drug benefit.

"This was a program enacted as part of a very high-profile, partisan controversy," Rother said. "And the other thing is, the benefit is not what people had hoped to see."

Rother said AARP, which has partnered with an insurer to provide a drug plan, believes people should view the drug coverage much like homeowner's or car insurance.

"It's really peace of mind that you're buying," he said. The program has an out-of-pocket cap feature that limits the yearly amount a particular participant would have to pay for medicines.

Congress passed a prescription drug benefit in 2003 as part of the Medicare Modernization Act. Under the program, beneficiaries can voluntarily enroll in a private plan that pays for a portion of their prescription drugs.

People will pay a monthly premium, an annual deductible and a portion of each prescription. Additional financial aid will be provided to those with low incomes.

The federal government will spend an estimated $720 billion over the next 10 years to subsidize beneficiaries' drug purchases.

The inspector general for the Health and Human Services Department recommending on Wednesday that the government be prepared to give millions of older people personal attention if they expect them to enroll.