Mary Rogers is not yet 65, “but it's coming, and you have to be prepared,” she said. Rogers, who turns 65 next year, is referring to signing up for Medicare and choosing a Medicare Part D prescription drug plan. On Saturday, the new enrollment period for Part D begins. People already on a plan must re-enroll in a plan for 2009 by Dec. 31.

Rogers has a multifaceted approach to assessing which drug plan will best suit her down the road. She met with Donna Cusick, director of development for the Allen County Council on Aging, who helped Rogers enter the drugs she takes into the Medicare-PartD.com Web site. The site lists all 2009 drug plans for each state and allows consumers to do a comparison based on their needs. She plans to have her son-in-law, a drugstore manager, check the store chain's Part D database for which Indiana option is best for her.

As Medicare enters the third year for prescription drug coverage, new rules on how those plans can be marketed are in effect. One major change: no more door-to-door sales or marketing of Part D and Medicare Advantage plans. The latter are plans in which the beneficiary opts out of traditional Medicare and enrolls in a private Medicare-approved plan that offers medical and drug coverage.

“The regulations give insurers … guidance on what types of marketing activities are acceptable and what types are not acceptable,” said Kerry Weems when the new rules were unveiled. Weems is acting administrator of The Centers for Medicare and Medicaid Services (CMS), which oversees Medicare.

Since the program began, Medicare has used “secret shoppers,” people who pose as prospective purchasers and who listen to insurance agents' sales pitches, review printed and broadcast ads, and read through forms for clarity and accuracy.

Last year's secret shoppers uncovered three insurance organizations that were not following federal guidelines. This year, CMS has tripled the number of secret shoppers.

“We think it's a good thing they're cracking down on the rather loosey-goosey ways,” of marketing Part D, said Melissa Durr, CEO of the Indiana Association of Area Agencies on Aging (IAAAA). The agency is a resource for people wanting information on Medicare plans and other services for older adults and people with disabilities.

One of the biggest areas of confusion has been with what CMS refers to as MA-PD, or Medicare Advantage Prescription Drug Plans. Some people purchased the plans because of the great drug coverage, but failed to read or understand the fine print. Some medical benefits covered under traditional Medicare are not covered under MA-PD plans. For example, rehabilitation services after breaking a hip or having a stroke may not be covered in a long-term care facility. Traditional Medicare automatically covers at least the first 20 days, sometimes more, when a person on Medicare goes from hospital to nursing home. That is not necessarily the case for MA-PD.

“You've got to be a smart consumer,” said Rebecca Baker, a projects manager at IAAAA, comparing some plans to buying a cell phone “with all the bells and whistles you may not need.”

On the other hand, for the person who may need hospitalization in the coming year, who takes a lot of medications and has one or more chronic health conditions, some MA-PD plans, despite higher premium cost, are better. They may cover the infamous Medicare “doughnut hole.”

“There's no way to get around the doughnut hole,” Baker said. That term refers to the situation in which the beneficiary has reached a plan's initial out-of-pocket co-pays/deductibles. If expenses continue, the person must reach the next threshold before the plan kicks in again, which is why some consumers would fare better with an MA-PD plan, even if the premium is higher. She cautions that plans vary, and people must do their homework.

Discerning the best plan has been easier as Part D continues, said Fred Taube, a volunteer counselor with the Indiana Senior Health Insurance Information Program, or SHIIP. SHIIP counselors don't sell plans. In fact, Taube said, “We're precluded from recommending them.”

In Indiana, 48 Part D and 46 Medicare Advantage plans are available for 2009, said Taube, who is glad to see the new marketing regulations. He has heard of free meals, gift cards to stores for people who purchase a plan, and aggressive marketing near pharmacy counters or near the front door of a store. None of those tactics is allowed this year.

In the first year for Part D, the program was besieged by complaints on lack of phone access to counselors and inaccurate information disseminated on the 1-800-Medicare line. Improvements have been made and, according to an April announcement by CMS, an independent survey of beneficiaries showed a greater than 85 percent satisfaction with Part D.

Yet the Journal of the American Medical Association (JAMA) earlier this year reported lack of understanding of Part D continues. Researchers also found while non-adherence to taking medications as prescribed because of cost of the drugs decreased after Part D took effect, among beneficiaries who are the sickest, little or no improvement in non-adherence was found.

And while fewer hang-ups at the Medicare Part D help line are being reported, and the new marketing regulations will enable consumers to get less-biased information, signing up “is still a grueling process.”