SCARBOROUGH, Maine - Just four months before enrollment begins, the Bush administration has begun a cross-country public relations campaign to sell its most significant domestic policy initiative: the new Medicare drug benefit. But it is encountering skepticism from some consumers, whose participation is critical to the program's success.
In a stop here, four top Bush administration officials, including the surgeon general of the United States, said the drug benefit would be a boon to retirees, worth $1,300 a year to a typical recipient and much more to those with low incomes.
But the officials offered none of the details that would have allowed beneficiaries to judge for themselves. Crucial information, like the monthly premiums and the names of covered drugs, will not be available until mid-September.
After hearing federal officials praise the program for about 45 minutes, Joan M. Jenness, 72, of Bridgton, Maine, said: "I heard nothing I had not heard before. I still have lots of questions."
Everyone enrolled in Medicare is eligible for prescription drug coverage. But public opinion polls suggest that many people have not heard about the new benefit or do not understand it, and many have not decided whether to sign up for it.
The economics of the new program depend on the assumption that large numbers of relatively healthy people will enroll and pay premiums, to help defray the costs of those with high drug expenses.
People who said they were healthy said they saw no immediate need to buy the drug coverage available from Medicare. People who said they were ill said the benefit seemed meager. And local insurance counselors said they shuddered at the complexity of the new program.
Federal officials arrived in a big blue bus painted with the message that people could sign up for the drug benefit on Nov. 15, for coverage beginning on Jan. 1. Officials face a huge task in trying to educate 42 million beneficiaries about a drug benefit that differs radically from the traditional fee-for-service Medicare program.
Dr. Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services, explained why federal officials were here. "What matters most," he said, "is not what happens in Washington, but what happens all over the country as people make decisions about their health care and prescription drug coverage."
In deciding whether to sign up for the drug benefit, people will want to evaluate whether they will be getting their money's worth. That depends, in part, on how much they spend on drugs.
Health policy specialists say the new benefit will generally be a good deal for low-income people, who are entitled to extra subsidies, and for people with drug costs exceeding $5,100 a year, since Medicare will pay about 95 percent of the cost of each prescription beyond that point. People who have solid drug coverage from other sources, like a former employer or the veterans' health program, may not see a need to sign up immediately for the Medicare drug benefit.
The event here was held at the Southern Maine Agency on Aging, a nonprofit group that offers counseling and other services to the elderly. Federal officials are counting on such agencies to help beneficiaries select drug plans.
As he welcomed visiting officials to this Portland suburb Wednesday, Laurence W. Gross, executive director of the agency, described the drug benefit as "one of the most important changes in Medicare in 35 years."
But Gross has yet to persuade his mother, Lisette V. DeBruycker. "I'm betwixt and between," said DeBruycker, 81. "I don't take any medications aside from an occasional aspirin. What will the new program do for me?"
Medicare needs healthy people like DeBruycker to sign up for the program because their premiums will help cover the costs of people with high drug expenses. Insurers say the new program cannot survive if the only people who sign up are heavy users of prescription drugs.
Richard E. Robbins, 72, said he would probably sign up, although he uses only a few hundred dollars' worth of drugs in a year. "It's a no-brainer," he said. "The drug coverage is a safety net. We never know from day to day what our needs will be."
Many Democrats adamantly opposed the drug bill when Republicans pushed it through Congress in 2003. Democrats denounced the measure as a giveaway to drug companies and insurers. But Gov. John Baldacci of Maine, a Democrat, is working with the Bush administration to help people enroll.
"This is not the drug benefit we would have designed," said Jude E. Walsh, the governor's top adviser on pharmacy programs. "But we have no choice. It's coming whether we want it or not. We are trying to make it work for vulnerable people in the state of Maine."