Gloria Hoffman's Vanishing Rx Coverage

In February 1997 Gloria Hoffman, a widow living in Kansas City, Mo., became eligible for Medicare and joined a Medicare HMO. This is her five years' experience:

• 1997: Enrolled in a "deluxe" plan costing $25 a month that offered better benefits than the standard plan with a $0 premium. Doctor visit: $5. Specialist visit: $10. Prescription drug copays: $10 for 30-day supply retail, or $20 for 90 days by mail order. Unlimited drug coverage for generics; brand names capped at $1,200 a year.

• 1999: Premium nearly doubled to $49 a month. Doctor visit raised to $10, specialist visit to $15. Cap on brand name drug coverage reduced to $750 a year.

• 2000: After surgery for breast cancer, she started a five-year regimen of tamoxifen citrate prescribed by her oncologist. Copay for the drug cost $20 for each 90-day supply by mail order.

• 2001: HMO's "deluxe" plan no longer available. Enrolled in standard plan with $0 premium. Doctor visit raised to $15, specialist visit to $20. Brand name drugs no longer covered. Mail order pharmacy told Hoffman that tamoxifen citrate was not a generic, as she'd supposed, so she would have to pay $256 for a 90-day supply. Seriously alarmed, she appealed to health plan, which as a special case granted her coverage for the one drug. But she still pays top dollar for other brands.

• 2002: Premium raised from $0 to $45 a month, almost as much as she used to pay for better benefits. "Let's face it, the plans are trying to survive," she says. "But so am I."