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Anyone who thinks turning 65 is a time to relax and reap life's rewards probably hasn't encountered Medicare open enrollment.

It takes some work.

The process includes a choice of 49 prescription-drug plans, all with different formularies.

And anyone opting for a Medicare replacement plan, which private insurers offer to replace traditional Medicare, faces 58 different choices.

Open enrollment for Medicare in 2009 began Saturday and ends on Dec. 31.

As happens every year, the complex enrollment rules and choices catch many seniors off-guard. Adding another headache for this year's enrollees: higher premiums for Medicare Part D prescription-drug coverage for people who don't select the proper plan for their needs.

"I have no idea what I should be doing," said George Hovey, a retired city of Tucson employee who'll turn 65 in December. "I'd like to just keep the insurance I had as a city employee."

Hovey attended a three-hour workshop at Tucson Medical Center Saturday to help ease him through the enrollment process. But after listening to the instructions and picking up two Medicare enrollment booklets — each with more than 100 pages — he remained confused.

The availability of Part D plans for low-income enrollees will decrease in 2009, says a recent Kaiser Family Foundation report. And the average monthly premium for Part D plans will increase by 14 percent to $45.45, though it will vary widely by region, the report adds.

Anita Asquith, 80, said her monthly premiums for Medicare Part D have more than tripled over the last three years, now costing her $41 per month. She attended an enrollment seminar at TMC over the weekend, searching for help in choosing a different plan. With the 49 to choose from, she was overwhelmed.

"It's not a kind system," said Lydia Baker, coordinator of Medicare and health-care assistance for the Pima Council on Aging. "Because of what it takes to navigate, it's terrible for someone who is old and frail, or who is young and disabled.

"This whole thing came about because Congress said seniors need more choice. But I'm still waiting for a senior to come in and say they like all this choice. They would rather have richer benefits and the stability of knowing their doctor will stay with their plan," Baker said.

But David Sayen, administrator for the U.S. Centers for Medicare and Medicaid Services region that includes Arizona, said Wednesday that the number of choices available is a good thing — that it ensures everyone has something to suit his or her needs.

Medicare officials also note that plans and people change, which is why it's wise to review plans and make use of the help that's available to navigate them.

"We understand it does take some thought," said Jack Cheevers, Medicare and Medicaid Services spokesman. "The idea behind the Part D legislation was to open it up to more competition, to keep drug prices low."

Cheevers said people should be looking not only at premiums but at other factors, such as whether their neighborhood pharmacy is contracted with the plan they select. He also advises against sending in enrollments at the last minute, because there could be a delay in getting coverage.

Baker said one of the people she helped most recently was a 93-year-old retiree from General Motors. The company had always handled his health insurance but stopped this year, leaving him to enroll on his own.

"He doesn't know Medicare A from B — he didn't have to know," Baker said.

Tucson optician Luise Herwig, 63, also is perplexed. But she has a little more time. She is doing research so that she'll be prepared.

"Like a lot of things, I think it could be simplified," Herwig said. "Also, I plan to work well beyond the age of 65, so I'm not sure how that works, either."

There's also Medigap coverage to pay for some of the costs Medicare doesn't cover. There are 12 standard plans. But coverage for long-term care, dental work, eyeglasses and hearing aids is not included in any Medicare plan.

Asquith said she's hoping the Medicare system will change under the next administration. She'd like to see more government regulation of how private insurers set premiums and other prices for the Part D drug program. President-elect Barack Obama already has said he wants the government to negotiate directly with pharmaceutical companies for lower prices.

Baker believes the system needs some kind of overhaul.

"I think if members of Congress had to spend one day with me and meet the beneficiaries of Medicare, they would craft it differently," said Baker, who has been working with Medicare clients for 15 years. "I think they are listening to the insurance and pharmaceutical companies more than they are listening to the people receiving Medicare."