Last August, Kay Kramer substituted Mozart and poetry for the migraine medicines Imitrex and Neproxin, cutting the monthly cost of his Medicare prescription drug plan by $44, or about 20 percent.

On Friday, Medicare launched an online comparison tool to help seniors choose their drug coverage for next year, and Kramer learned that a slice of his savings will disappear. Costs are edging up in his HealthPartners, Medicare-endorsed drug insurance plan.

Across the nation, millions of Medicare beneficiaries -- and the baby boomer children who help them -- will start to compare costs this month as open enrollment nears for the fourth year of the Medicare Part D drug benefit. (The plan-comparison tool is at www.medicare.gov).

Some beneficiaries will switch to cheaper plans when open enrollment begins on Nov. 15. Despite Medicare's urging, however, most won't bother to compare plans and will stick with what they've got.

It could make a big difference.

More than 17 million aged or disabled Medicare beneficiaries are now covered by the voluntary Medicare Part D plans. Another 10 million have similar plans offered by employers. In Minnesota, more than 575,000 beneficiaries have drug coverage under Part D or employers. About 140,000 have no drug coverage.

For Kramer, 69, a retired Honeywell factory worker with epilepsy, emphysema and other health problems, total drug costs next year will rise slightly, from about $3,100 to $3,220.

But if he were to pick the wrong plan, his costs next year could shoot past $10,000.

Hitting the 'doughnut hole'

Kramer will look at his options -- he could find a cheaper plan. But he likes his type of plan, called a Medicare Advantage plan, because it covers both health care and drugs. "And I like HealthPartners. With my health, I want to stick with a good, reputable company I know,'' he said.

An added benefit: His plan covers all drugs on its formulary through the dreaded "doughnut hole," a gap in coverage under many plans where the beneficiary pays all drug costs.

Perhaps a quarter of beneficiaries will hit that coverage gap this year.

In Minnesota, hundreds of beneficiaries struggling with doughnut-hole costs are calling the government-supported Minnesota Senior LinkAge Line or the Minnesota Senior Federation.

Both offer phone help to beneficiaries who want to compare costs and coverage of the drug plans. Both also help low-income Minnesotans sign up for a government subsidy that pays much of a beneficiary's costs.

To qualify for the subsidy program, Medicare beneficiaries must have an annual income below $15,600 ($21,000 for a couple) and savings below $11,990 ($23,970 for a couple).

"People really need to compare their plans because we know the premiums are rising for next year and we can guess that many drug costs will rise as well," said Kelli Jo Greiner, a Medicare specialist with the Minnesota Board on Aging that sponsors the LinkAge Line.

For plans covering only drugs, the average premium will rise from $41.35 this year to $48.23 in 2009, up 17 percent.

It was not immediately clear Friday how the average drug premium for Medicare Advantage plans in Minnesota will change. Earlier, Medicare reported that combined premiums for drugs and health coverage will drop slightly.

In addition, there will be fewer plans that offer drug coverage in the doughnut hole.

Doing the homework

"I really do my homework, both on Medicare and my medical issues," said Kramer, an advocate for people with disabilities who has served on the National Council on Disability and recently on the Crystal Human Rights Commission.

"That's how I got to listening to classical music and writing poetry again. It really helped end my migraines, at least for now," he said. "Anything you can do to reduce your drugs is good for your health and good for your budget."

Kramer got caught in the doughnut hole a couple of years ago and "I had to work pretty hard with my doctors to get different medicines," he said.

"Getting the proper medicines and the proper health care, that's pretty important for older people. That's why this Medicare drug stuff is important."

Warren Wolfe • 612-673-7253