With only four days before the deadline, thousands of the state's senior citizens still haven't signed up for Medicare prescription drug coverage.

"We really had hoped they wouldn't wait until the last minute, but it seems we're getting lots of calls from people who are just starting to look at it now," said Pamela Cunningham, director of the Sage PLUS program at the Executive Office of Aging.

Cunningham said no exact numbers are available, but several thousand out of the about 186,200 Hawai'i senior citizens eligible for the program haven't signed up.

The program, known as Medicare Part D, is a drug coverage insurance program going into effect this year and is intended to save money for most participants. The initial sign-up period began on Nov. 15 and will end Monday at midnight.

Some people have criticized the program as being overly complicated, requiring senior citizens to sift through proposed insurance coverages for their prescriptions to get detailed information about drugs and dosages. They then can choose from among more than 60 insurance plans offered by 18 companies.

State and county agencies report that calls asking for help with the plans jumped in the past week and say they are bracing for more inquiries as the Monday deadline nears. The state's Sage PLUS office said daily calls spiked to 90, or nearly three times the office's average volume.

While some senior citizens and their families have been able to wade through this information on their own, others are turning to the help lines established by Medicare and local governments. All of Hawai'i's county governments said they are receiving calls from the elderly asking if they should join or whether their current plans are better than what's being offered.

"We're noticing more of a pickup this last week as the deadline approaches," said Karen Miyake, of Honolulu's Elderly Affairs Division. She said her office's four staff members have been working overtime to accommodate the calls and are trying to decide whether to work during the weekend.

On Kaua'i, the county Agency on Elderly Affairs will have five outreach workers who normally work outside its office on hand Monday to help field calls and service walk-ins.

Cunningham said her volunteers will work this weekend, answering telephones and returning messages.

She said that in some instances the calls are simple to answer because the person already has coverage that exceeds the Medicare program, but other queries may take multiple calls to sort through, including getting people to fill out a form and helping them enroll.

Cunningham said Hawai'i state and county retirees, as well as people with Veterans Affairs drug benefits and the military's TRICARE for Life, typically have drug coverage that is as good as Medicare is offering.

Medicare beneficiaries waiting until after the Monday deadline to join the new drug program will have higher premiums, assuming they ultimately sign up. The next enrollment period will begin Nov. 15.

While it is complicated, Cunningham said, signing up for the program can yield savings. She said she knows of people who are going from spending $600 a month on drugs to spending $120.

The premium for the Medicare drug plan is estimated at $27 each month for Hawai'i. Senior citizens in the plan also will have to pay the first $250 of drug costs for the year and cover 25 percent of the costs between $251 and $2,250.

Part of the difficulty in deciding whether to join is determining the so-called "doughnut hole," where a gap in coverage exists. After seniors exceed $2,250 in annual drug costs, they are responsible for paying 100 percent of the next $2,850 in costs.

On the other side of the gap, Medicare will cover 95 percent of drug expenses above $5,100.

Cunningham and others cautioned against seniors waiting till Monday to call or start the sign-up process because they might not be able to pull all of the required information together and choose a plan in time.

"If a person procrastinates too long, they could miss out on an opportunity that could help them," she said.

Reach Greg Wiles at gwiles@honoluluadvertiser.com.