Julie Nicks studied Medicare's new prescription drug benefit. She attended meetings, called help lines and analyzed many of the 46 plans available in South Carolina.

"I talked with everybody who would listen to me," the 84-year-old James Island resident said. "And I'm still not going to do it."

Nicks doesn't spend much on drugs and said she believes she doesn't need to sign up, for now.

She's not alone. Halfway through the signup period for the biggest benefit expansion in Medicare's 40-year history, millions of seniors are standing on the sidelines.

According to new figures released Wednesday by the federal Centers for Medicare and Medicaid Services, about 25 million of the nation's 43.4 million Medicare beneficiaries are enrolled in a drug plan. However, only 4.9 million have signed up voluntarily; the rest were enrolled automatically because they already received prescription coverage through government or private plans.

That leaves about 18 million who haven't signed up and don't have "creditable coverage" - retiree coverage from a former employer that has been deemed better than the new plan - which means they may have to pay a penalty if they sign up after the May 15 deadline.

In South Carolina, 86,695 of the state's 654,000 Medicare recipients have signed up voluntarily for a drug plan, while 251,000 haven't signed up and don't have creditable coverage. The number of people covered by Medicare or other plans is 403,259.

Medicare's drug plan is largely voluntary, but waiting can cost money. Seniors who sign up after May 15 will pay an additional 1 percent in premiums for every month they wait. In addition, they will face a six-month waiting period for coverage, which means their premiums will be at least 6 percent higher than if they sign up before the deadline.

Officials are unsure why so many seniors are avoiding the plan. Some may have been discouraged by tales of problems with the plan that have circulated since it began paying for medicines on Jan. 1.

Mike Leavitt, secretary of Health and Human Services, acknowledged those problems Wednesday but said they're being ironed out. "Whenever you have a new program that affects 25 million people, you're going to have some snags."

Leavitt noted that 250,000 to 400,000 seniors sign up for the coverage every week. "We wouldn't be having (that many) enroll a week if it wasn't a good deal for seniors," he said.

Helen Gulledge wavered about whether to enroll, because, she said, the number of choices and the way the plans are set up made the decision too complex. Then she got help from Vasco Pickett, a semi-retired insurance broker.

Gulledge, who lives in the Bishop Gadsden retirement community on James Island, takes 15 medications every day. Her drug bill was $7,000 last year.

After spending hours researching plans, Picket helped Gulledge enroll in one offered by Humana. The plan will cut Gulledge's prescription cost to $4,160.

"It's really not that complicated," Gulledge said. "You just need a little help."

As for Julie Nicks, she hasn't written off the idea of signing up eventually. She is aware of the penalty. She also knows she has almost three months left to sign up.

"I could change my mind this afternoon," she said.

Reach Jonathan Maze at 937-5719 or jmaze@postandcourier.com.