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As seniors begin picking their Medicare prescription-drug insurance plan for 2009, they face average premium increases of 24 percent.

The 10 programs covering the greatest number of Americans - a combined 60 percent of Medicare participants - will increase their premiums by more than 30 percent. That's on top of an average 21 percent increase for the top 10 plans in 2008, says Avalere Health, a Washington-based health care strategy firm.

Seniors must decide by Dec. 31 which Medicare prescription-drug insurance plan they will use in 2009.

"2009 is a critical test of consumers' loyalty to their Medicare drug plan," said Bonnie Washington, vice president of Avalere Health.

"In the past, seniors may have been better positioned to stomach annual premium increases, but with rising costs of essentials and falling home values, these monthly increases may prove to be too steep to ignore."

Under the Medicare Part D program, seniors and other Medicare patients pick a private prescription-drug plan from among a group of plans approved by Medicare. The federal government covers some of the costs.

Even recipients happy with their current plans should review and compare plans every year, Medicare officials say. That's because prices and formularies - the lists of drugs that plans cover - can change from year to year.

Comparisons can be tricky. Some plans with low monthly premiums might include higher deductibles and require larger copayments. The reverse also can be true.

Among plans listed on the Medicare Web site as available in Greensboro, monthly 2009 premiums range from $15.20 to $128.50.

Moreover, many plans change formularies from year to year.

And plans vary, and may change from year to year, in whether and how they cover a gap, often called the doughnut hole, in coverage they provide.

The doughnut hole works like this: After you and your plan have paid a certain amount for drugs, you must pay for your drugs out-of-pocket until you reach a total for the year at which "catastrophic coverage" kicks in.

At that point, you resume paying only small copayments for your drugs for the rest of the calendar year.

As you try to figure out your best choice, both Medicare and the N.C. Department of Insurance are offering Web sites that compare plans available in North Carolina on such issues as monthly premiums and deductibles. The insurance department also has a toll-free number people can call for information about plans.

Contact Lex Alexander at 373-7088 or lex.alexander@news-record.com