A survey released Thursday suggests low enthusiasm and confusion among seniors toward the new Medicare prescription-drug benefit, just days before the government is set to begin enrollment in the plan.

Only 20 percent of seniors now say they plan to sign up for the benefit, which begins a six-month enrollment on Nov. 15. Thirty-seven percent say they won’t enroll in the program; 43 percent say they don’t yet know if they will sign up.

Researchers said they expect at least some of that 43 percent to eventually sign up for the plan, which starts offering benefits Jan. 1. But nearly half who don’t plan to enroll say that they don’t believe the plan will save on drug costs; more than one-third say the plans are too complicated.

“If the enrollment were held today, a lot of people would not sign up,” said Robert J. Blendon, a professor of health policy at Harvard University and a co-author of the survey.

The survey was released by the Harvard School of Public Health and the Henry J. Kaiser Family Foundation, a nonprofit group. It sampled 802 American seniors and carries a margin of error of plus or minus 3.5 percent.

Bush administration officials have crisscrossed the nation since the summer promoting the program, also known as Medicare Part D. Seniors have also been hit with advertisements from private insurance companies and others offering plans on Medicare’s behalf.

But the promotions appear to have had little effect on seniors' understanding or opinions of the program.

Senate Passes $10 Billion in Health Cuts

Complex Choices

Sixty-one percent of beneficiaries surveyed say they do not understand the new benefit, while 25 percent say they understand it well or very well.

At the same time, the percentage of seniors who say they won’t enroll rose from 33 percent in the same survey in August to 37 percent today.

“It is still clear that many seniors still don’t understand the benefits,” said Mollyann Brodie, PhD, a Kaiser vice president and the report’s other co-author. “There seems to be a good deal of confusion.”

Starting Nov. 15, most of the 43 million seniors in Medicare face a complex set of choices for Part D benefits. Most states have more than 40 plans, and even sparsely-populated Alaska is expected to have 27 plans, according to the federal Center for Medicare and Medicaid Services.

That is likely to surprise many seniors, according to the survey. Just 5 percent said that they expected to choose from more than 20 plans.

Prices for Brand Name Drugs Up 6.1 Percent

Officials: Be Patient

Bush administration officials de-emphasized the survey results in a briefing with reporters Thursday. Health and Human Services Secretary Michael Leavitt said that he has received “extremely positive” feedback about the benefit during his promotional trips. Leavitt had just returned from a public relations tour of the South to tout the benefit.

“”It’s going to take time for seniors to be comfortable,” Leavitt said. “Enrollment may start off slowly, but we’re confident that over time people are going to like the benefit.”

Drew Altman, PhD, the Kaiser Foundation president, said it was too early to tell whether Thursday’s numbers portend poor enrollment for the benefit, which is estimated to cost taxpayers more than $750 billion over the next 10 years.

The benefit “is so complex, I just don’t think seniors are going to know until it’s real for them,” he said. “I would say success or failure is very much up for grabs.”

By Todd Zwillich, reviewed by Louise Chang, MD

SOURCES: Henry J. Kaiser Family Foundation/Harvard School of Public Health: "The Medicare Drug Benefit: Beneficiary Perspectives Just Before Implementation." Robert Blendon, professor of health policy, Harvard School of Public Health. Mollyann Brodie, PhD, vice president, Kaiser Foundation. Michael Leavitt, secretary, Department of Health and Human Services. Drew Altman, PhD, president, Kaiser Foundation.