Medicare’s new drug plan was supposed to help people like Charlotte and Walter Kuglin – retirees living on a modest income who pay for their prescriptions out of pocket.

The Florida couple are among the millions of seniors too well off for Medicaid but not lucky enough to retire with employer-based drug coverage.

The Kuglins, however, decided not to enroll in the program, known as Medicare Part D. They figure they will spend less buying their drugs the way they have for more than three years – by mail from Canada.

“When you are on a fixed income like we are, you have to watch every penny,” said Charlotte Kuglin, a 75-year-old retired nurse anesthetist.

Many seniors have yet to sign up for Medicare drug coverage because they are confused by the array of plans – each with its own premiums, co-pays, deductibles and lists of covered drugs and participating drugstores. But others are making a calculated choice to opt out – and buy from foreign pharmacies instead.

These seniors are not bothered by the idea of relying on prescriptions filled by foreign pharmacists. Indeed, some say they prefer the ease of shopping by mail.

And many have accepted the risk of paying a penalty if they change their minds and sign up for the Medicare program after the May 15 deadline. What matters most is how much they are spending now.

Gov. Kathleen Sebelius and Mike Leavitt, U.S. Health and Human Services secretary, discuss the new Medicare prescription drug plan in Topeka. The Jan. 26 meeting with Leavitt didn't persuade Sebelius or Sandy Praeger, state insurance commissioner, to change their position in favor of postponing the May 15 deadline for Medicare-eligible seniors to enroll in one of 41 drug plans offered in Kansas. Sebelius said she'd pursue the issue with the state's congressional delegation.

Half of the $1.5 billion worth of drugs shipped by foreign vendors into the U.S. each year comes from Canada. RxNorth, a Minnedosa, Manitoba-based mail-order pharmacy, reports a small slowdown in orders from its biggest base of customers – American seniors – since Medicare launched the drug program Jan. 1. But Chief Executive Andrew Strempler said he wasn’t worried.

“Medicare is not going to put us out of business,” he said.

For many, “we’re still significantly less expensive than Medicare,” Strempler said.