More than 34,000 enrollees in the Aetna, Personal Choice and Keystone plans will be paying as much as $65 more a month in premiums. Aetna members will pay more at the pharmacy for their drugs; members of the other plans will pay more for the same (or reduced) drug benefit. 

"The changes in our premiums reflect the medical costs we're experiencing," said Jennifer King, spokesperson for Aetna. "The federal reimbursement rates have been capped at 2 percent annually, while we're facing medical inflation of 4 to 10 percent a year, plus 17 to 20 percent [more] for pharmacy costs. 

"We've tried to give members options that will retain their choice but still be affordable," King said.   

In fact, managed-care companies have been lobbying all week to get Congress to give millions more to Medicare HMOs. As of today, they face fierce resistance from the Democrats, many of whom argue that the HMOs are already far overpaid.

Starting in the 1980s, Medicare HMO plans were designed as a way for patients to receive extra services not provided by Medicare by paying an extra fee and agreeing to go to certain doctors and hospitals. 

Typically, the managed-care companies have charged relatively low premiums and depended on Medicare for reimbursements. 

But within the last year, 65 healthcare management organizations nationwide have dropped their Medicare contracts completely, and another 53 have reduced service somewhere in the country (including Aetna). 

In Bucks, all four Aetna Medicare plans will be collapsed into one starting Jan. l. Premiums - which now range from $10 to $40 a month - will be $50 per month, and the pharmacy benefit will bereplaced by a "discount" pharmacy plan, a system where enrollees get 10 to 40 percent off drug costs. Previously patients just had to pay a $10 to $30 co-pay. 

Margaret Estok won't find the new prices easy to live with. The Falls retiree has to take seven medications that cost upwards of $275 a month. She only receives $451 a month in Social Security 

"What are we senior citizens to do?" she said. "I cannot afford to pay for my prescriptions. I'm only 66. Why do I have to dip into my savings?" 

Estok said she couldn't consider leaving the Aetna plan because she already has a doctor she knows and trusts. But even if she did, there are not many choices for her. 

The two other plans in the area, Keystone 65 and Personal Choice 65, will also rise in price this January. Keystone 65 will go from no monthly premium to a $60 a month fee; Personal Choice 65 subscribers will go.from an average $100 monthly premium to an average of $117 a month. 

While Medicare HMOs have been around for about three years, some health care policy experts believe that Medicare HMOs are a waste of time and money. 

"We have a lot of research that shows Medicare HMOs use much more money than would be under if those services were included in the regular program," said Amanda McClasky, the director of health policy analysis for Families USA.

For example, a third of Medicare payments go to HMOs, says McClosky; but only 16 percent of Medicare members are enrolled in HMOs. 

Just last year, Medicare HMOs received an increase from Congress, McClosky said, and many dropped out of the program anyway. 

"I'm hard pressed to believe that throwing money at them is a good way to solve the problem," she said.