Блог Анкара

In This Chapter

^ Recognizing the importance of comparing plans carefully

^ Making lists to compare plans effectively

^ Comparing Medicare drug plans on the Internet

^ Getting personal help to compare drug plans

Edicare advises people who are choosing a Medicare prescription drug plan to consider the three Cs — Cost, coverage, and convenience. That’s perfectly true. But I say add three more Cs — Compare, compare, compare! And even a fourth: Do it Carefully! I can’t emphasize this point enough: Comparing plans carefully is the single most important step you can take in finding the Part D plan that’s best for you. It may save you unexpected hassle. It’ll certainly save you money.

"Well, yeah," you say. "But what about the fact that I’m faced with more than 80 drug plans in my area? And they’re all different!" I know that the number of plans makes choosing just one — let alone the right one — seem a daunting prospect. But take heart, because you don’t have to grope your way through the multitude of all of those plans. In this chapter, I demonstrate a strategy for navigating the Part D maze that focuses only on Your Needs.

First, I explain why comparing plans properly is better than the less-than-ideal alternatives you may be considering. I also share how to make two simple (yet essential!) lists of your needs and preferences to help you get the most out of an invaluable tool: the online Medicare Prescription Drug Plan Finder. I walk you through this tool step by step so you can whittle all those plans to a manageable few in the fastest and most effective way. I then show you how to drill down into a plan’s details to help bring you to a final choice. Finally, I suggest ways of getting personal assistance comparing plans, if you need it. In essence, this chapter’s purpose is to help you avoid that queasy feeling that often comes after making an important decision — did I do the right thing?

Understanding the Need to Compare Plans Carefully

There’s a famous scene in Indiana Jones and the Last Crusade Where Indy and his enemy choose what each thinks to be the Holy Grail from an array of goblets. The evil Nazi picks a gold one, and instantly dies a horrible death. "He chose. . . poorly," observes the ancient knight who’s been on guard duty for about 700 years. Indy picks a simple wooden cup. "You," intones the knight, "have chosen. . . wisely."

Well, maybe the Part D plan that’s best for you isn’t the Holy Grail exactly. But you still need to choose wisely to get it. And there are so many poor ways of choosing. Like these:

U Picking the same plan as your spouse, your best friend, your next-door neighbor, or your second cousin. (Why? Because they’re not you! They don’t take the same prescription drugs as you.)

U Choosing the plan with the lowest premium in your area. (Why? Because, unless you don’t take any drugs right now, premiums are far less important than co-pays in adding to your out-of-pocket expenses under any plan.)

U Agreeing to enroll in a plan that a sales agent pitches to you at a shopping mall, local pharmacy, senior center, or anywhere else.

(Why? Because the agent’s talking up the plan he’s paid to sell, without a thought to your personal needs or preferences.)

U Picking a plan from the marketing brochures that plans send to your home. (Why? Because these are advertising materials designed to make a sale, again without regard to your own circumstances and needs.)

U Deciding on the plan with the most familiar name. (Why? Because it won’t necessarily cover your drugs at the least cost.)

Using any of these methods to choose a plan isn’t much better than closing your eyes and jabbing a pin in a list, because none of them account for the prescription drugs that You Take. Your own set of drugs — down to the exact dosage of each and how often you take them — is the most important factor in picking the plan that’s right for you. It’s the essential key to choosing wisely.

In the next two sections, I explain how to recognize the best plan for your needs and why comparing plans carefully is worth the effort.

What’s the best plan, anyway?

In theory, the best plan is the one that provides any prescription drug you may conceivably need, not just now but also in the unforeseeable future. But that’s

Not how Part D works. No plan covers every drug, as I explain in Chapter 4. And unless you can find out the drugs that each plan covers and count them all up — a daunting task considering many plans have thousands of drugs on their formularies — it’s impossible to know which plan covers the most.

IJ$jAB££ I believe that the best plan has to be the one that covers all, or almost all, of the drugs you’re taking Now — meaning the time when you’re deciding which plan to sign up for — at the lowest out-of-pocket cost and with the fewest hoops to jump through to get those drugs. If it turns out later on that you need a drug that’s not on your plan’s formulary, you can ask your doctor whether an alternative formulary drug may work as well for you (as explained in Chapter 16). Otherwise, you can try using the exceptions process to ask the plan to cover your prescribed drug (see Chapter 4) or, if you’re turned down, you can appeal the decision (see Chapter 19).

You can also change to another Part D plan at the end of the year during open enrollment (or during the year in certain circumstances, as explained in Chapter 17). In fact, it’s wise to compare plans annually, because they change their costs and benefits each year, so the plan that’s best for you this year may not be as good for you next year.

Is comparing plans Worth the effort?

Comparing plans carefully is definitely worthwhile! Doing so tells you

U Which are the three or four plans that cover all of your prescription drugs but cost you the least out of pocket over the whole year.

U Which of these plans has the fewest or no restrictions for your drugs. (Different kinds of Restrictions — prior authorization, quantity limits, or step therapy — are described in Chapter 4.)

U Which of these plans gives you the best discounts if you choose generic drugs or want to receive your meds by mail order.

U Which of these plans has the most reasonable Co-pay structure — that is, the different amounts you pay in each tier of charges — in case you need more meds later in the year. (For example, Plan X may charge a co-pay of $45 for all of its nonpreferred brands, whereas Plan Y may charge more than $100 for drugs in its own nonpreferred brand tier.)

U Whether you’re going to fall into the Doughnut hole (also known as the coverage gap; see Chapter 15 for full details) with the set of drugs you take now and, if so:

• At which point in the year that’s going to happen.

• Whether that’s going to occur later under one plan than another.

• Whether any of these plans cover Your Drugs in the doughnut hole.

U Which of these plans have network pharmacies convenient for you.

U Which of these plans have a mail-order option, if you want one.

U Which of these plans allow you to fill your prescriptions in any state if you travel or live away from home for part of the year.

Certainly, you can find the answers to a few of these questions just by reviewing the Medicare & You Handbook, which gives some details of all Part D plans in your area. (Medicare mails this publication to you each October.) Or you can look at individual drug plans’ marketing brochures and Web sites. But you won’t find answers to all of your questions, or even to the most important one of all — which plans cover your drugs at the least cost.

The only really effective way of getting that critical information is to create the lists of your meds and plan preferences and use the online Medicare Prescription Drug Plan Finder, or get someone else to use it for you, as explained later in this chapter. This tool is also the Safest Way of choosing a plan. Why? Because when you do the comparison, you remain in control. You can’t fall for a sweet sales pitch — or worse, fall prey to a scam or a hard sell from some unscrupulous person who exploits your uncertainty for personal gain. (See Chapter 11 for the scoop on marketing scams and hard sells.)

Will you avoid Part D buyer’s remorse?

Most folks don’t compare Part D plans before choosing one, period. Surveys show that most often they rely on word-of-mouth recommendations or choose a plan sponsored by an insurer with a familiar name. So I’m guessing millions of Part D enrollees out there are paying far more than they need to for their drugs. Here are a few examples of how comparing plans carefully can save you money — and how failing to do so can teach you a hard lesson.

Bill’s story: Going by a Well-knoWn name

Back in November 2005, a few weeks before Part D started, I was having dinner at a friend’s house when another guest, Bill, told me he’d signed up with a plan. I asked how he’d chosen it. Well, he’d picked an insurer whose name he knew and felt he could trust. Fine, I said, but let’s do a comparison. We borrowed a laptop, and I ran the information for his six meds through the online Medicare Prescription Drug Plan Finder. It took about 15 minutes. The least expensive plan — also provided by a well-known insurer — turned out to cost about $1,000 a year less than the one he’d chosen. Because we were still within the open enrollment period, he was able to switch plans. Every year since then I’ve run the numbers for Bill. And every year the plan that worked out best for him was different than the plan he’d had the year before.

Joel’s story: Choosing the same plan as your spouse

Before he retired, Joel had health insurance from his company that covered drugs for both himself and his wife, Mae. When they needed Part D, Joel left it to Mae to pick a plan for both of them, because she took a lot of drugs, and he rarely took any, and they felt more comfortable being in the same plan. So Mae chose Plan X, which covered all of her drugs for a monthly premium of $61, and signed them both up. Mae was okay, but Joel was actually wasting money. Because he almost never needed drugs, he’d have been better off on Plan Y, which had a premium of $12.10 (the lowest in his area) and would’ve saved him $48.90 a month, or $586.80 over the course of the year.

Joanne’s story: Failing to research a sales pitch

Joanne was in the mall buying gifts for her grandkids when a sales rep invited her to sit down, have a cup of coffee, and talk about Part D. Joanne already had a plan and wasn’t thinking of changing it, but she was happy to take a load off and listen for a few minutes. What the rep said about Plan X sounded like a better deal than her current plan, so Joanne signed up on the spot. What she didn’t know was that for her set of drugs (two brand-names and two generics) Plan X ranked 27th in expense out of the 51 drug plans in her area. If she’d compared the plans according to the drugs she took, instead of listening to a sales pitch, she’d have found Plan Y. This plan had higher premiums than Plan X. But Plan Y charged lower co-pays for her generics ($4 per prescription rather than $8) and placed her brands in its preferred brand tier (with co-pays of $25), whereas Plan X placed them in its nonpreferred tier with co-pays of $55. So over the course of the year, Joanne paid $1,764 with Plan X, whereas she’d have paid $996 under Plan Y — a savings of $768.

Getting Organized With Two Crucial Lists

The information you must have at hand before comparing Part D plans properly — whether you hop online and use the Medicare Prescription Drug Plan Finder yourself or get someone else to do it for you — is very simple. All you need (besides your zip code, which you already know) is

U An accurate list of your prescription meds

A list of personal preferences that may make you lean toward one plan rather than another

In the following sections, I explain how to make your drug list complete and accurate in all of its details and how to note the kinds of preferences that may be important to you.

Creating an accurate list of your meds

Take a sheet of paper or use the worksheet provided in Appendix A. Have in front of you all of those bottles that contain the prescription medications you’re currently taking — tablets, capsules, liquid solutions, sprays, creams, or whatever form they come in. Then make a list of their exact names, their dosages, and how often you take them (frequency), Using the information provided on the pharmacist’s labels. Alternatively, you can ask your pharmacist for a printout of all of your prescription drugs.

Whichever method you choose, your list should look something like Table 10-1 — but with details for your own drugs, of course, in place of my examples.

I’m not just being persnickety in saying you should note down these three items — name, dosage, and frequency — exactly as they’re written on the container label. Following are some good reasons for being strictly accurate with each one:

U Exact medication name: Many prescription drugs have the same name but come in different forms, with their differences marked by a second word or combination of letters following the name.

For example, verapamil hydrochloride, a generic drug used to treat high blood pressure, irregular heartbeats, and chest pain, is shown in Table 10-1 as verapamil HCL ER. The ER Stands for extended release, but this drug is also available in three other variations: a plain form (without additional letters); an SR Form (sustained release); and a CR Form (controlled release), meaning the drug is absorbed into the body at different rates. Because this drug is a generic, a plan’s co-pays for any of these forms are likely the same — but the full price of the SR form is generally twice as much as the ER or CR forms, which makes a difference in the deductible or doughnut hole. So using the wrong initials in a plan search can distort your overall out-of-pocket cost results.

W Dosage: Using the wrong dosage in a plan search may also distort your cost results. Part D plans often charge the same co-pay for different strengths of the same drug — but not always. Even the full price may be the same for different dosages — but sometimes it isn’t. In this case, you pay more for a higher dosage in the deductible period (if you have one) or in the doughnut hole (if you fall into it), and also if the plan you choose charges Coinsurance (a percentage of the price) for your drugs in the initial coverage period rather than fixed co-pays. (I explain the difference between co-pays and coinsurance in Chapter 3.)

W How often you take your drugs: Of the three factors that can alter your out-of-pocket costs during a plan search, frequency is the most important. If, by mistake, you say you take a pill Once A day when in fact you take it Twice A day, the search results will show a cost that’s half as much as you’ll actually pay when filling your prescription at the pharmacy. That’s one surprise you don’t want! The converse is just as distorting. If, for example, you take a drug once a Week, But by mistake say in a plan search that you take it once a Day, The results will show an out-of-pocket cost seven times higher than what you’d actually pay.

The accuracy of the costs you’re quoted in a plan search depends very much on the accuracy of the drug names, dosages, and frequencies you enter into the plan finder. These details are equally important if you ask someone else — such as a customer representative on the Medicare telephone help line, or a counselor at your State Health Insurance Assistance Program (SHIP) — because this person, too, is going to use Medicare’s plan finder to assist you. (I explain how to find personal help with comparing plans later in this chapter.)

Drawing up a list of your plan preferences

Finding a plan that covers all of your drugs and costs you the least out of pocket may be top on your list of priorities. But chances are high that you’re going to identify several Part D plans that cover your drugs and vary by only a few dollars in the overall amount they charge. So consider some other factors that may be important to you, like these:

W Are the pharmacies in this plan’s network convenient to where I live?

Each plan has its own network of pharmacies, and going to a pharmacy outside that network costs you a lot more (maybe even full price) for your drugs. (See Chapter 14 for more on this topic.) Before finally selecting a plan, you need to be sure it has network pharmacies within a reasonable distance of your home.

W Does this plan have a mail-order option? If you prefer to receive all or some of your prescriptions by mail order in 90-day supplies (which costs less in many plans), you need to be certain that the plan offers a mail-order service. Some plans don’t. (I discuss mail order in more detail later in this chapter.)

W Does this plan restrict any of my drugs? Any plan may require you to ask permission before it’ll cover certain drugs through restrictions known as prior authorization, quantity limits, or step therapy. (I explain these requirements and how to deal with them in Chapter 4.) Because plans impose restrictions on different drugs, you’ll want to look for a plan that has the fewest restrictions on your drugs, or none at all.

W Will this plan cover my prescriptions when I’m away from home? If

You expect to travel during the year or live in another state for part of the year, you want a plan that covers your prescriptions at network pharmacies throughout the United States. Some plans offer a national service and some don’t. (None cover drugs purchased abroad.) See the later section "Searching for pharmacies if you travel or live away from home for part of the year" for more information.

W Does this plan have a good customer service track record? Plans that answer calls without keeping you on hold forever, respond to questions properly, pay their share of prescriptions correctly, and deal with complaints promptly are obviously preferable. Some plans provide more satisfactory customer service than others. See the later section "Assessing customer service" for details.

So how do you sort out the wheat from the chaff on all of these questions? The answers are available through Medicare’s online plan finder, and I show you how to find them later in this chapter. If you’d rather not go online yourself, you can get a hand comparing plans as explained in the later section, "Finding Personal Help to Compare Plans."

Introducing the Medicare Prescription Drug Plan Finder

Medicare’s online prescription drug plan finder is an interactive Web site that allows you to plug in details of your own prescription drugs to find out which plans cover them and approximately what each plan will charge you. In other words, this tool makes light work of an otherwise difficult calculation by doing the math for you automatically. I walk you through the process step by step later in this chapter.

You can use the plan finder to compare Part D coverage and costs within

W Stand-alone plans (PDPs), which provide Only Drugs and are the type of plan you need if you’re enrolled in traditional Medicare for your medical coverage

W Medicare Advantage plans (MAPDs) that provide prescription drugs and medical coverage in one package

W Special Needs Plans (SNPs), which in some areas offer comprehensive care for people in certain situations, such as living in a nursing home, being chronically ill, or receiving Medicaid services

Using the plan finder to compare coverage and costs for your drugs is essentially the same process within all these groups. But if you’re considering a Medicare Advantage or Special Needs plan, you need to compare details of the medical services they provide as well as drug coverage. I explain why in Chapter 9.

Everybody who wants impartial information about Part D plans uses the online plan finder. And I mean everybody! Not only people in Medicare but also doctors, pharmacists, social workers, counselors, advocates, and help groups. Gee, that sounds an awful lot like anybody who’s assisting a Medicare beneficiary in finding a Part D plan! Clearly, everyone depends on the plan finder. So it’s reasonable to ask: How reliable is it?

The plan finder is a complex and sophisticated computer program. And it’s unique: No other insurance system offers consumers a way to compare plans head-to-head to find the best deal. But of course such comparisons are only as reliable as the pricing information fed into them — in this case, by the Part D plans themselves.

Medicare officials say they rigorously monitor the accuracy of plan prices and, when errors are detected, remove all information about that plan from the Web site until corrections are made. Medicare also includes pricing accuracy as one of the measures in its quality assessment system, which rates individual plans from one star (poor) to five stars (excellent). Officials say the ratings, displayed on the plan finder, are based on Medicare’s own regular reviews and the number of complaints it receives from consumers.

Nonetheless, the plan finder isn’t free from glitches and errors. Here are some tips for avoiding, or minimizing, your chances of choosing a plan based on misleading information, as well as how to deal with it if you accidentally do:

W Know that Medicare posts new plan information for the following year in mid-October. This is when the potential for pricing errors is most likely, because every plan changes its costs and benefits from year to year, and huge amounts of detail are being uploaded onto the system. If you do a plan search at this time, recheck the information after open enrollment starts on November 15.

W After you’ve used the plan finder to choose the plan you like best, but Before Enrolling in it, it’s sensible to

• Double-check the accuracy of the drug information you entered into the plan finder — especially dosages and frequency.

• Print out the plan’s complete details for your set of drugs and keep this hard copy with your records.

• Call the plan to verify the full price it charges, or will charge for next year, for each of your drugs (at the dosages and quantities you specify) and your co-pay or coinsurance amounts during the

Initial coverage phase. If you’re considering getting your drugs by mail order, ask for those prices and co-pays too because they may be different. Keep notes of this conversation; the plan likely won’t confirm the details in writing.

W Bear in mind that although plans’ fixed costs, such as premiums,

Deductibles, and co-pay tiers, are invariably accurate on the plan finder, the prices quoted for drugs are an estimate. The exact prices can vary according to the pharmacy you go to and may fluctuate during the year.

W If you discover errors, report them to Medicare. Your information will be investigated and fed into its quality rating system. (See the later section "Discovering omissions or discrepancies on the plan finder" for some scenarios to watch out for and how to resolve them.)

W If you believe you were misled into enrolling in a plan due to

Erroneous pricing information on the plan finder, you have the right to ask Medicare for a special enrollment period to switch to another plan.

This scenario is when keeping a printout of the details you got from the plan finder comes in handy, because you probably need to show evidence.

The plan finder is now vastly more user-friendly than when it first went live in October 2005, and every year Medicare introduces improvements. So it’s possible that adjustments made for 2009 and beyond will slightly alter the navigation steps I explain in the rest of this chapter. I don’t expect such alterations to be great enough to trip you up as you follow the steps, though some of the link details may change. However, if you get stuck, know that every fall I update my "Quick Route Through the Medicare Drug Plan Finder" guide on the AARP Bulletin‘s Web site. You can find it at Bulletin. aarp. org/yourhealth/.

Moving Step by Step through the Medicare Plan Finder — The Fast Way

The Medicare Prescription Drug Plan Finder is loaded with information and offers several different kinds of searches. But in this section, I focus on a quick way of getting to a plan comparison without you having to give out your Medicare ID number or any other personal details, except for your zip code and drug list. This procedure is a totally anonymous process.

On a technical note, it’s also a process that’s best tackled with high-speed Internet access. You can do it with a dial-up connection, but your search will be slower and, for that reason, more frustrating. Perhaps you can use high-speed access at a friend’s house, a library, or a local senior center.

If you don’t have access to the Internet or just don’t feel up to doing an online search yourself, you can skip this section and go directly to the later section that suggests ways of getting personal help to find the same info.

JttNG/ If you have yet to create the all-important lists of your current prescriptions and your drug plan preferences, flip back to the earlier section "Getting Organized with Two Crucial Lists." Without this information at your fingertips, you can’t use the plan finder to full effect and won’t obtain accurate enough information to be able to compare plans properly.

The following 15 simple steps are designed so that you can sit at your computer and use them to navigate the plan finder, keystroke by keystroke. Sometimes I tell you to ignore certain questions or information. This is stuff you don’t need right now, but that you can return to later when you begin to compare plans in detail, according to your circumstances and preferences. (I consider those details in the next section.)

1. Go to Www. medicare. gov and click "Compare Medicare Prescription Drug Plans" on the home page.

If you’re doing this search anytime from mid-October through December 31, you’ll see two links — one that leads you to plan information for this year and the other to plan information for next year. Just click the one you need.

2. Click "Find & Compare Plans."

3. Click "Begin General Search" in the right-hand box.

Ignore "Begin Personalized Search" in the left-hand box.

4. Enter your zip code.

5. Ignore the age and health status boxes.

6. Select the "No" buttons for the next three questions and click "Continue."

Note: If you qualify for Extra Help, you need to click the third button and answer the questions that appear in order to obtain accurate information about your costs as you progress through the plan finder. So look at the specific information about choosing a plan in Chapter 5 before going further.

If you live in an area with a zip code that spans more than one county, you may now be directed to a page that asks you to select the county you live in.

7. Ignore this page (Review Current Coverage and Consider Options) and click "Continue."

8. Click "Enter My Drugs."

9. Enter the name of your first drug in the box and click "Search for Drug."

Another box appears, showing several drug names. Click the one you take and then click "Add Selected to Your Drug List." (You can also use the alphabetical list to search for your drug.) The drug you’ve selected then appears in a list box. This box also tells you whether a generic version of each drug is available.

10. Repeat this search for each drug you use and click "Continue."

When all of your drugs are on the list (but before clicking "Continue"), click the little box below the list to remove the check mark to ensure that lower-cost generics aren’t automatically substituted for your specific meds. (I explain how you can use the plan finder to discover more about using generics or other alternatives to lower your drug costs later in this chapter.)

11. Change the listed dosages and quantities to exactly match what you take.

This is the most critical step in the process in terms of finding out what you’ll pay for your drugs in different plans, as explained in the earlier section "Creating an accurate list of your meds."

• Dosage: If your exact dosage doesn’t appear beside each drug name on the screen, use the dropdown menu to find it and click that dosage. For example, if Lipitor is one of your drugs, you’ll see the default given as 10 mg, but you can change this dose to 20, 40, or 80 mg. (If no menu appears, only one dosage exists for that drug.)

• Exact form of drug: If your drug comes in different forms (such as extended or controlled release), these variations are identified by their initials and appear together with dosages on the same dropdown menu. Click the exact form you take.

• Quantities: Plug in how many doses you take each month. For example, if you take two pills a day, delete the default of 30 a month and type in 60. If you take a drug less frequently — say once every three months — use the dropdown menu to make that change. Click "Continue."

12. Choose whether to save your drug list.

Saving your list is a good way to avoid having to enter your information all over again if you lose it through a computer crash, or if you want to resume your drug plan search later on.

Select a password date that’s easy to remember, such as your birthday, and click "Continue." You’ll then receive a 10-digit ID number to use when retrieving your list. Make a note of the number and then click "Continue." (If you don’t want to save the list, click "Skip this Step.")

13. Ignore the invitation to select a pharmacy and click "Continue."

Selecting a pharmacy is unnecessary at this stage and may prevent you from finding plans that are the least expensive for your drugs. Searching for pharmacies separately, at a later stage, is a safer method. (I explain this search in the later section "Examining retail pharmacy choices.")

14. Arrive at the page headed Your Personalized Plan List.

What you now see is a list of five stand-alone drug plans, which the plan finder has ranked as the five least expensive plans for You At pharmacies in your area. The ranking automatically takes into account the cost of premiums and the drugs you’ve entered under each plan. If you want to see drug information for Medicare Advantage or Special Needs plans in your zip code instead, click those links at the top of the page.

To see more plans in your area, click the "10 per page," "20 per page," or "All one page" links at the bottom of the plan list. All the plans are ranked in Ascending Order of your likely total out-of-pocket costs for the year, so the plan shown first is the least expensive.

15. Pat yourself on the back for getting to where you can start narrowing down your options.

This page is actually the beginning, not the end, of your search, because it shows only the broadest information. But you can see — as the simplified version used as an example in Table 10-2 also shows — that it already gives you, in the second and third columns, an idea of what you can expect to pay out of pocket over the whole year in each plan, either at retail pharmacies or by mail order. (The dollar amount includes premiums, drug co-pays, and costs in the deductible and coverage gap phases, if applicable.)

The plan finder’s rankings are based on the expense of drugs purchased at the various plans’ in-network retail pharmacies, as you can see in the second column of Table 10-2. But the plan finder also shows likely costs for the same drugs when purchased through each plan’s mail-order service. These amounts are often (though not always) lower than the retail pharmacy cost. As a result, the order of the plans in terms of overall expense changes. Plan X may be the least expensive under the retail pharmacy option, but Plan Y may be least expensive under mail order. Note: The "Lower this cost" link in these two columns refers to alternative drugs that you may be able to take to reduce your costs further, as I explain later in this chapter.

Table 10-2 Example of a Personalized Plan List from the

Plan Finder Comparison Tool

Source: Medicare Prescription Drug Plan Finder, Www. medicare. gov, 2008.

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Careful, though — this page doesn’t give the whole picture. So don’t stop now. To make an informed choice among your plan options, you need to get cozy with their details, as I explain in the next section.

Drilling Down to Drug Plan Details

The list of plans — which I call the Main plan list — described in the preceding section’s Step 14 gives only a general idea of coverage and costs. Now you need to look at the details of each plan — or at least of the four or five plans that head the list.

To start, click the name of the first plan at the top of the left-hand column. This action brings up a page headed Plan Drug Details, which gives a lot of information about your drugs and costs under the selected plan. When you’re finished looking at this plan’s details, click your browser’s back button to return to the main plan list. You can then click the next plan’s name to bring up its details.

You can also look at the details of up to three plans side by side at the same time. Click the little box to the left of each plan’s name on the main list and then click the "Compare" button above.

TWNG/ Notice that this format is more compressed and doesn’t display the particulars as clearly as the full plan details pages. It also omits two important bits of information — whether your drugs come with any restrictions (such as prior authorization, quantity limits, or step therapy) and bar graphs that show your monthly out-of-pocket expenses over the year. That’s why I recommend looking at each details page in turn rather than taking the shortcut offered by this side-by-side comparison.

Here’s an explanation of what’s on each details page as you scroll down:

W Plan quality ratings: This rating system uses stars to indicate a plan’s performance in certain areas — such as customer service, getting prescriptions filled, accuracy of quoted prices, responsiveness to complaints, and so on — based on Medicare reviews and consumer complaints. Stars range from one (poor) to five (excellent).

W Fixed costs: These expenses refer to the plan’s monthly premium and annual deductible, if applicable.

W Estimated out-of-pocket cost over the whole year (including premiums):

This info appears in two dollar amounts — one shows your total costs if you buy all of your drugs from preferred retail pharmacies in your plan’s network (30-day supplies), and the other shows your total costs if you buy meds by mail order (90-day supplies). Mail order is usually (though not always) less expensive, but some plans don’t offer this option. (If you’re looking at this page partway through the year, the right-hand column shows total costs for the remainder of the year.)

W Drug coverage information: This breakdown shows the list of drugs you entered into Medicare’s online plan finder and the Tier (level of charges) that applies to each drug. Tiers typically range from 1 (least expensive) to 4 or 5 (most expensive), as explained in Chapter 3. (To find out the actual co-pays for these tiers, click "View Important Notes and Benefit Summary" on the menu at the top left of the page.)

If any of your drugs aren’t covered under this plan, the phrase NOT ON FORMULARY appears in the Tier (Formulary Status) column.

The columns farther to the right are very important. They show whether the plan places restrictions on any of your drugs — that is, whether you need to obtain the plan’s permission before they’ll be covered. These restrictions are prior authorization, quantity limits, or step therapy (as

Explained in Chapter 4.) When you make a final choice among plans, you may want to choose one with few or no restrictions.

W Monthly drug cost details at preferred network retail pharmacies: This chart shows what each of your drugs, if purchased from a preferred retail pharmacy in your plan’s network, will cost on a monthly basis at four different coverage levels:

• The period before you meet your annual deductible (if the plan has one)

• The initial coverage phase when you pay co-pays or coinsurance

• The coverage gap (doughnut hole) when you pay 100 percent of the cost of your drugs, unless this plan covers them in the gap or your costs aren’t high enough to reach it

• The catastrophic phase of coverage when you pay low co-pays after reaching a certain out-of-pocket expense limit

The left-hand column on this chart shows the full price of each of your meds under this plan — that is, the price the plan has negotiated with the manufacturers. You pay this price before meeting your deductible or while you’re in the coverage gap. If the full price also appears in the Initial Coverage Level column, it can mean one of two things — either the drug isn’t covered on the plan’s formulary or the full price is less than the co-pay would be, so the plan charges you the lower of the two. If you see a co-pay rather than the full price in the Gap column, it means the plan covers this drug in the gap.

W Monthly drug cost details when purchasing drugs by mail order: To

See a similar chart showing mail-order costs, click the "Show" button on the right-hand side. (If the plan doesn’t offer mail order, this option doesn’t appear.) Although mail-order drugs are always bought in 90-day quantities, this chart shows costs by the month (30-day quantities) to make comparisons easier.

W The local pharmacies within this plan’s network: Knowing which of your local pharmacies are in the plan’s network is important, because going out of the network costs you a lot more, possibly even full price. If you follow the instructions in the previous section, you won’t see any pharmacies listed. So how can you find out which of your local pharmacies participate in the plan? I explain how in the "Finding the pharmacies in a plan’s network" section later in this chapter.

W Out-of-pocket costs at a month-by-month glance: The bar chart at the end of the details page is a useful way to see how your expenses may change from month to month under this plan and whether (or when) you’re going to fall into the doughnut hole. (For examples, see Chapter 15.) If the plan has no deductible and your drug costs are too low to take you into the doughnut hole, the cost for each month is the same. Otherwise, different monthly amounts appear according to coverage level. For a detailed breakdown, click "Show explanation of these costs."

The bar chart you see on this page shows monthly costs if you buy your drugs at the plan’s in-network retail pharmacies. To see a similar bar chart for mail-order costs (if the plan offers this option) click the "Show" button on the Cost Estimator for Mail Order Pharmacy panel.

I go into more detail on these bar charts as they relate to the doughnut hole in Chapter 15.

W Filling prescriptions outside your home area: If you travel or live in another state for part of the year, you need a plan that covers your prescriptions at its network pharmacies anywhere in the U. S. To find this information, click "View Important Notes and Benefit Summary" on the menu at the top left of the page. The summary indicates whether you can use this plan to get your prescription drugs outside its service area.

W How this plan’s costs next year compare to its costs this year: When you’re doing a plan search during open enrollment (November 15 through December 31), the plan finder shows the details of Next Year’s costs and benefits by default. To see This Year’s information, click "Click here to display [year] plan data" at the top of the page. This option disappears on January 1.

If you click "View Important Notes and Benefit Summary" and nothing happens, your Web browser may be blocking pop-ups. Disable your pop-up blocker to access this information.

Making Additional Worthwhile Searches to Help Pick a Plan

If you’ve looked at the details of the first several plans on the main plan list, you may now have a rough idea of which ones seem the most promising. But, once again, don’t stop here. You need more information before making a well-educated choice among the handful of plans you’re now considering. In the following sections, I suggest other worthwhile searches, along with some relevant tips and warnings. These sections explain how you can use the online Medicare Prescription Drug Plan Finder to explore the following six topics in depth: examining drug coverage details, lowering your drug costs, determining mail-order prices, making pharmacy choices, assessing customer service, and filling prescriptions away from home.

When you’ve done these additional searches and are ready to make a final selection, print out the details of your top four plans and compare them, point by point. You can use the worksheet in Appendix A to make the comparison easier.

Looking at the nuances of drug coverage details

The plan finder shows a lot of information about drug coverage on each plan’s details page. But as you dive in, consider the info in the following sections to help you understand some nuances that aren’t immediately apparent or that may puzzle you.

Reviewing the pricing of covered drugs

When examining a plan’s details page for the prices of your covered drugs, some items may strike you as odd. Here are the explanations:

W If a drug is covered but shown as full price in the initial coverage period, that’s probably because the full price is lower than the co-pay, so the plan charges you the lesser of the two amounts. You can check this by looking at the plan’s usual co-pay for the relevant tier of charges — click "View Important Notes and Benefit Summary" on the menu at the top of the page. For example, if the full price of your Tier 2 drug is $15.50, but the normal co-pay for Tier 2 drugs is $20, you’re charged the lesser amount.

W If you see that Drug X is charged as a co-pay in the Gap column, whereas Drug Y is charged at full price, then Drug X is one of the drugs that this plan covers in the doughnut hole, but Drug Y isn’t.

W If you see an odd-looking price in the initial coverage column — for example, $23.97, rather than a nicely rounded dollar amount like $24 — it means that this plan charges coinsurance, not a flat co-pay. (Flip to Chapter 3 for more on coinsurance and co-pays.) So the price shown is a percentage of the full price.

W If you see that the cost of a drug in the Catastrophic Coverage column is higher than the standard catastrophic co-pay — $2.25 per prescription for generics or $5.60 for brand-names in 2008 ($2.40 and $6.00 respectively in 2009) — it means that you’re being charged 5 percent of the drug’s cost instead of the co-pay. Under Part D law, you pay either a co-pay or a maximum 5 percent of the full price, whichever’s the higher amount.

W If the full cost of your drugs is very high, you may see what seems to be a most peculiar profile for your monthly out-of-pocket expenses on the bar chart at the end of each plan’s details page. The chart may show a very large amount in the first month’s column (amounting to several thousand dollars) and very small amounts for the rest of the year. That’s because your drug costs are so high that you go through the deductible (if any), the initial coverage period, and the doughnut hole in the very first month. The small amounts thereafter are low-cost catastrophic coverage.

W If you look at the bar charts for drugs purchased by mail order, you may notice a strangely uneven profile in your out-of-pocket expenses over the year — for example, $400 in months 1, 4, 7, and 10, and $25 in the other months. That’s because you’re buying your drugs in three-month supplies, in advance. During the second and third month of each quarter, you have no outlay, except for the plan’s premium ($25 in this example).

Finding the pricing for drugs a plan doesn’t cover

Be aware that you can’t tell just by looking at the main plan list whether all of your drugs are covered by any particular plan — or whether a plan imposes restrictions on any of them. For that, you have to go to each plan’s details list and look at the Drug Coverage Information section (see the earlier section "Drilling Down to Drug Plan Details"). Drugs that a plan doesn’t cover have NOT ON FORMULARY next to their names. But wait, there’s more!

The main plan list and each plan’s details page show a dollar amount representing your estimated annual cost under each plan. But that amount Includes the full price of any drug that the plan doesn’t cover. The plan finder presents the information this way because, if it excludes the price for an uncovered drug completely, the overall cost of that plan appears lower than what you actually pay. Including the full price of an uncovered drug in the overall estimate gives you a better idea of what your out-of-pocket expenses are likely to be under that plan, especially when you’re comparing it with the costs of a plan that covers this drug.

A plan may cover a specialty drug (usually Tier 4 or higher) if you purchase it from a network pharmacy — but may not if you get it from the plan’s mail-order service. So when looking at mail-order prices, be sure to check out this info.

Discovering omissions or discrepancies on the plan finder

When you can’t find something you’re looking for, or the information seems wrong, there may be an explanation or it may be the result of a glitch or error on the plan finder. In the following scenarios, if you need to report the

Problem to Medicare, call the help line at 800-633-4227:

W You enter the name of a drug, and the plan finder doesn’t find it. First, check that the name you’re entering is spelled correctly or try to find it on the alphabetical list provided. Verify that the med in question is a prescription drug and not an over-the-counter drug or a vitamin — Part D doesn’t cover these kinds of medication. If nothing checks out, call Medicare to report the error, or to see whether there’s a reason this drug isn’t on the list.

W The plan finder doesn’t allow you to enter the dosage of your drug.

First, check that the dosage you’re trying to enter is correct, according to the medication label. If it’s right, report the omission to Medicare immediately. In the meantime, enter the dosage that’s nearest to yours — very often a plan’s co-pays are the same for similar dosages.

W The name of one of your drugs doesn’t appear in the cost details of the plan you’re looking at. First, check in the Drug Coverage column that the drug is in fact on your list of selected drugs. If it’s not, scroll down the page and add it to your list. If the drug is already on the list, but not showing up in the cost details, Medicare may have temporarily removed the information after discovering that this plan submitted incorrect pricing. Check back a day or two later. If it’s still not there, call Medicare to report the omission.

W The price given for a drug under one plan is very different from the price given under several other plans. Prices vary a good deal among plans, but mistakes happen. For example, occasionally plans submit the generic price to the plan finder rather than the specified brand-name price. You can check this by entering the name of the generic version on your drug list and seeing whether its price is the same as the price given for the brand-name. If it is, report that to Medicare immediately.

Checking to see whether the numbers add up

Many people like to do their own math to see if the calculations made on the plan finder actually add up properly. In some cases, checking the math yourself is easy to do. For example, if a plan has no deductible and your drug costs aren’t high enough to take you into the doughnut hole, your out-of-pocket costs will be the same each month. Just add the cost of the premium to your monthly co-pays — then look at the bar chart at the bottom of the plan’s details page to see whether the monthly totals displayed there are the same. Multiply this monthly total by 12 to check the annual out-of-pocket cost shown at the top of the page.

Calculating costs on your own is much trickier if the plan has a deductible and/or your drug costs are high enough to take you into the coverage gap — or through the gap and into catastrophic coverage. In these situations, your monthly costs fluctuate according to the coverage level — and the change from one to another most often doesn’t fall neatly at the end of any given month. The calculation is Possible. But quite frankly — and I speak from experience — you can go nuts trying to figure it out with pen and paper, or even with a calculator. In these circumstances, you probably need to have faith that the figures on the plan finder are pretty much correct.

Lowering costs with alternative drugs

You can dramatically reduce your costs if any of the brand-name drugs you take now have a generic version or a similar, older alternative that your doctor thinks would work just as well for your medical condition. I discuss these kinds of medications and why they’re less expensive than brand-name drugs in detail in Chapter 16. But in this section, I show you how to find lower-cost alternatives and their comparative prices on the plan finder.

In Step 10 of my navigation guide in the earlier section "Moving Step by Step through the Medicare Plan Finder — The Fast Way," I advise you to remove the check mark from the little box at the end of the list of drugs you’ve entered. That’s because, if you leave the box checked, the plan finder automatically replaces the names of your drugs with generics, if any exist. It can be a shock to see a totally unfamiliar name appear in your drug list without realizing what’s happened. And it seems to me that you’d prefer to find out the prices of your prescribed drugs Before Looking to see whether any lower-cost alternatives exist. That way, you know how much you’d save if you switch to the alternatives.

Here, I assume that you’ve searched plans on the basis of the drugs you’re taking now and have a shortlist of the plans that work out least expensively. Now you can see whether those costs can be brought down further. Choose a plan on the main plan list and click "Lower this cost" in the second column. Or click the plan’s name to get to the plan details page and click "Lower My Cost Share" on the menu at the top left. The page that appears on your screen will look like the example in Table 10-3.

Source: Medicare Prescription Drug Plan Finder, Www. medicare. gov, 2008.

Do your drugs have any lower-cost alternatives?

As you can see in the example in Table 10-3, the plan finder shows you which brand-name medication has a similar drug that can be used instead, which has a generic version, or which has no alternative. (Not all brand-name drugs have alternatives to date, as I explain in Chapter 16.) The list shows the percentage and dollar differences in co-pays or coinsurance between the brand-name drugs and the suggested alternatives. And it shows the savings over a month — in this case, almost $100.

If these cost savings sound too good to be true, let me assure you that this example is the result of an actual search using this set of drugs. What’s more, Zoloft isn’t covered on the formulary of this particular plan — the odd figure in the second column shows the full price — but the generic Is Covered, at a fraction of the price. (Under a different plan, which covers Zoloft as a nonpreferred Tier 3 drug with a co-pay of $54 a month, using the Tier 1 generic version reduces the co-pay to $4.)

On-screen, this page shows drug costs at retail pharmacies. You can also see the mail-order costs by clicking "Show Mail Order (90-Day Supply) Prices" at the top of the list. Opting for mail order may bring down your costs even further. Under the plan used for the example in Table 10-3, the similar drug (for Lipitor) and the generic (for Zoloft) each cost nothing under the mail-order option, reducing the overall monthly cost by half, to $15 a month.

As usual in Part D, savings on lower-cost drugs vary a great deal among plans. So after examining these details under one plan, look at similar cost savings for other plans on your shortlist by using the same steps. As a result, a different plan may now work out as the least expensive for you.

And what about that fourth column on the right-hand side of Table 10-3? This column shows whether any of the drug manufacturers’ patient assistance programs offer this drug for free or at low cost for eligible people with limited incomes. (I describe these programs as a possible way of lowering costs in the coverage gap in Chapter 16.) If a "No" appears in that column, it means the drug isn’t available under an assistance program. If a "Yes" appears, you can click it for details about the program — including the income limits for qualifying and how to apply.

One more useful bit of information is on this page. Notice the State Programs heading above the chart. These are State Pharmacy Assistance Programs (SPAPs) that are offered in some states for people whose incomes are limited but who don’t qualify for Medicaid. Clicking the link takes you to a page that provides details of the program in your state and how to contact it.

Which drugs would lower the cost?

If you find you can lower your costs with some alternative drugs, be sure to know their names and whether they require different dosages from the brand-name drugs you take now. You can locate this information on the plan finder by clicking the "Similar drug" or "Generic" link in the third column of the Lower My Drug Cost Share list. Doing so brings up a new list, which looks similar to the example in Table 10-4.

Source: Medicare Prescription Drug Plan Finder, Www. medicare. gov, 2008.

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This example shows Lipitor, one of a group of drugs called statins widely used to treat high cholesterol. Currently, it doesn’t have a generic form. But some older statins, such as Crestor and Zocor, do have generic versions, and these generics are the lower-cost options shown in the left-hand column.

Generics and similar older drugs sometimes require different dosages and/or quantities to achieve the same clinical effect as the brand-name drugs they’re copying. As you can see in Table 10-4, someone taking 20 mg of Lipitor once a day needs to take 40 mg of simvastatin once a day or 40 mg of pravastatin or lovastatin twice a day for these alternatives to work as effectively. Most plans charge the same co-pays for generics regardless of dosage or quantities (as this one does), but some may not. So be sure to check the co-pays when looking at your own drug list.

This chart also shows whether a drug manufacturer’s patient assistance program will cover the drug in question. When the given alternatives to the brand-name drugs are generics, as in this example, the answer is "No." If a given alternative is an older brand-name drug, the answer may be "Yes."

How do you use the information you find?

^jjfcDOQj^ If you discover an opportunity for lowering your costs through this kind of - search and decide that you want to try any of the suggested alternative drugs,

You need to talk to your doctor about whether the substitute may work well for you. Printing out the page that gives the names, dosages, and quantities for these alternatives and showing it to your doctor is a good idea.

Considering mail order

The third column of the main plan list shows at a glance an estimate of what each plan charges for your meds over the whole year if you buy all of them by mail order. If the plan offers a mail-order service — and if most of your drugs are Maintenance medications You take regularly, which makes getting them in 90-day supplies worthwhile — you may find that this option lowers your costs. (You can find examples of mail-order savings in Chapter 16.)

IJ$jWJ££ The savings generated by using this option vary a great deal among plans. You may find that the whole ranking of least expensive plans changes. For example, a plan that’s shown as the fifth least expensive under the retail pharmacy option may actually be number one under mail order. That’s because one plan may charge exactly the same for your set of drugs, whether by retail or mail order; another may charge a lot less for mail order over the whole year. For this reason, having a quick look at the mail-order costs for more than five plans is worthwhile. Some plans charge lower co-pays (as well as a lower full price) for mail order — for example, nothing for Tier 1 generic drugs, compared with $5 for retail. To see specifics, go to the details page of each plan you’re considering and click the "Show" button on Monthly Drug Cost Details at Mail Order Pharmacy.

If you’re considering mail order, reviewing the detailed list of monthly costs in the mail-order list for each plan is sensible. Some plans charge Higher Co-pays for mail order — for example, $7 for mail-order generics compared with $4 for generics from a retail pharmacy.

And here’s another important pitfall to watch out for: Some plans don’t cover certain drugs under their mail-order option at all, even though the same drugs are covered at a retail pharmacy. These are often Specialty drugs — the rarest and/or most expensive meds that are placed in a plan’s highest tier of charges — which you must buy at a pharmacy that stocks them. For example, one plan charges a monthly co-pay of $270 for a cancer drug purchased at retail pharmacies, but it charges full price — $743 — when the same drug is bought by mail order. The plan finder (at least in 2008) doesn’t highlight this fact. You have to look carefully at the mail-order cost list to find out. If the price of a drug shown in the Initial Coverage Level column on that list is the same as in the Full Cost of Drug column, the drug isn’t covered by mail order.

Examining retail pharmacy choices

Being able to use your plan coverage at retail pharmacies within a convenient distance from your home is obviously an important consideration when choosing a plan. (Even if you prefer mail order for your regular meds, sooner or later you may need a short-term drug, such as an antibiotic, purchased locally so you can start taking it immediately.) Most Part D plans, especially those offered by big insurance companies, have a wide selection of network

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Pharmacies, including large chains and smaller independent pharmacies. And many of the same pharmacies are within the networks of different plans.

When you’re enrolled in a Part D plan, you must go to one of the pharmacies within its network to ensure paying the price you expect. Going out of the plan’s network costs a lot more (unless you do so for an unavoidable, legitimate reason that your plan accepts, as explained in Chapter 14), and these payments don’t count toward the out-of-pocket limit that lifts you out of the doughnut hole (see Chapter 15).

The plan finder provides tons of info on pharmacy choices, but you need to tread carefully in your search, as I explain in the following sections.

Identifying the pharmacies in a plan’s network

In Step 10 of the earlier section "Moving Step by Step through the Medicare Plan Finder — The Fast Way," I advise you to ignore the invitation to select a pharmacy at that stage. Here’s why:

U If you click "Yes" (when asked "Do you want to select a specific pharmacy or pharmacies from which you prefer to purchase your drugs?"), a list of pharmacies in your area appears on-screen. But you have no way of telling which of these pharmacies are in any plan’s network.

U If you select a pharmacy on this list, the plan finder’s search engine looks first for plans that include the pharmacy in its network; your out-of-pocket costs are a secondary consideration. In other words, you may not find the least expensive plan.

U This list may include names that aren’t regular pharmacies, but may be doctors’ offices or hospital departments that dispense specialty drugs (such as medications used to treat cancer). Most plans don’t include these dispensers in their networks. If you select such pharmacies at this stage, the out-of-pocket costs that appear on the plan details page are going to be based on the full price of all of your drugs.

A better way to identify in-network pharmacies is to go to the individual plan details pages first, before searching for any pharmacy information, to get an idea of which plans are best for your set of drugs. Then you can find out which pharmacies are in the network of any plan you’re considering.

Click "View Pharmacy Network" on the menu at the top left of the plan details page to reveal a list of pharmacies within a certain distance of your zip code. (If this link doesn’t work, turn off your pop-up blocker.) In densely populated urban areas, this distance may be as little as half a mile. In rural areas, it may be seven miles or more. To widen the mileage radius, alter the distance shown in the box and click "Find Pharmacies."

The resulting list shows the pharmacies within the plan’s network, meaning that the plan covers any of its formulary drugs that you purchase there. The Pharmacy Type column to the right indicates which pharmacies supply certain kinds of drugs — for example, those that are Home infusion (self-injected) or Specialty Drugs (like some cancer medications). In the column at the far right, a Yes or No indicates whether pharmacies are preferred by the plan, meaning you may purchase your drugs at these locations at somewhat lower prices.

Comparing prices among in-network pharmacies

Even within the same plan’s network, different pharmacies may offer varying prices for your drugs. The out-of-pocket annual totals shown on the main plan list or at the top of each plan’s details page reflect the Average Of the prices offered by the plan’s Preferred Pharmacies in your area — that is, all those pharmacies with which the plan has negotiated the best discounts.

To see price differences for your set of drugs among specific pharmacies in each plan, follow these steps:

1. Go to the Main plan list, Scroll down to the My Pharmacies section, and click "Change Pharmacy Selection."

The result is a list of all the pharmacies within the smallest mileage distance of your zip code.

2. Expand the mileage radius to see more pharmacies farther away by scrolling down the page until you see the Change Criteria to Revise List of Pharmacies section.

You can alter the distance shown in the box by using the dropdown menu and clicking the distance you want. Then click "Update List." If the new list of pharmacies is large, you must click the "All one page" link to

3. Select your desired pharmacy by clicking the little box alongside its name and then click "Continue."

You can check up to two boxes, if you prefer. Either way, this step returns you to the main plan list.

4. Choose one drug plan by clicking its name.

The details page of your selected plan now appears with the prices charged at your chosen pharmacy. Its name is shown in the Full Year Cost and Monthly Drug Cost Details sections. If you selected two pharmacies, both appear in the Full Year Cost section. To see monthly cost details of the second pharmacy, click the "Show" button on the panel displaying that pharmacy’s name.

5. Observe whether your selected pharmacy is in this plan’s network.

See them all.

Be aware that this list shows All The pharmacies in your area and doesn’t specify which ones are in the network of any particular plan.

If it isn’t, note the warning message (above the Monthly Drug Cost Details section) that states: "You’ll pay 100% of the cost for drugs at this pharmacy because it is not in the plan’s network." In this case, only the full price of your set of drugs is displayed.

6. Return to the main plan list and repeat the process step by step to see prices at other pharmacies.

Comparing pharmacy prices this way can be a laborious procedure. So I recommend that for each plan you’re considering, check that a few familiar pharmacies are in the plan’s network (by clicking "View Pharmacy Network," as explained in the previous section) before doing anything else. Then select those pharmacies, one by one, as explained in Step 3. Make a note of each pharmacy’s annual overall costs for each plan you’re considering so you can compare them more easily. Remember that the prices of most pharmacies within each plan’s network vary only a little, but these prices can change during the year.

Iijj|kB£W The most important step is to make sure that the Part D plan you choose has at least one pharmacy in its network within a convenient distance of your home. And no, after you’re in a plan you Don’t Have to stick with one pharmacy from which to buy all or any of your drugs. If you have plenty of network pharmacies to choose from, you can always shop around among them when filling your prescription.

Knowing what to do if you already have a favorite pharmacy

You may especially like a certain pharmacy and you’d prefer to continue using it. Chances are pretty high that this pharmacy is in the network of at least one of the Part D plans on your shortlist, or even in all of them.

But what if it’s not? You can make a new search (using the pharmacy selection tool explained in the preceding section) to find another plan that has this pharmacy in its network. Then you need to compare this new plan’s costs with the prices of your shortlist plans. The difference may amount to only a few dollars over the year. On the other hand, the difference may be quite large. In that case, you need to consider whether cost outweighs convenience, or vice versa.

Assessing customer service

Naturally, some plans are better than others when it comes to providing good customer service and other kinds of performance. Medicare’s online plan finder helps you assess this, before you join a plan, by publishing quality ratings for each plan on its details page. This page includes an overall quality rating expressed in the form of stars and ranging from poor (one star), through fair (two stars), good (three stars), and very good (four stars), to excellent (five stars). This rating system gives a broad idea of how Medicare and plan enrollees have rated the plan overall.

But you can also drill down further to see how the plan rates on a range of specific performance measures — from how long it takes to get a live person on the phone to how well the plan handles appeals. To see this detailed breakdown, click the link labeled "Click to view more details on Plan Ratings" immediately above the stars. Doing so brings up a page showing three main areas of performance:

U Drug plan customer service: This category includes statistics on how long a plan keeps you or your pharmacist on hold during a call, how often such calls are disconnected in mid-conversation, how helpful the plan is in providing information, and how many complaints are filed about the plan.

*u Using your plan to get your prescriptions filled: This category indicates how easily enrollees get their prescriptions filled, complaints about the plan’s benefits and access to medications, complaints about problems met in joining or leaving the plan, and the frequency with which the plan delays making timely coverage determinations or appeals decisions.

*u Drug pricing information: This category focuses on the accuracy of prices submitted to the plan finder, the frequency with which a plan changes prices, and complaints about out-of-pocket costs, for example being charged the wrong amount for a prescription or a premium.

To see all the details in these three categories, click "Show All Plan Ratings" at the top of this page. Click "View Numbers" at the top left to see the actual numbers on which a plan’s stars are based (for example: time on hold — 25 seconds, or complaints about drug plan — 2.5 per 1,000 enrollees).

Medicare arrives at this information through regular monitoring of the plans, complaints from consumers enrolled in each plan, surveys among enrollees, and some independent assessments. You can see more details of how each point is measured by clicking "Click to view Data Sources" under each of the three category headings. If a plan is new to the Part D program, you may see the phrase "Insufficient data" next to some of the measures.

The more often enrollees let Medicare know how their plan is doing, the more useful these quality ratings become for people choosing a plan. So if you have a legitimate complaint about the plan you’re enrolled in, tell Medicare! Just call the Medicare help line at 800-633-4227 (877-486-2048 for TDD users) and say you want to file a Grievance — the Medicare term for a complaint. (I cover how to file a grievance in Chapter 19.)

Searching for pharmacies if you travel or live away from home for part of the year

If you travel a lot, you need a plan that allows you to fill prescriptions anywhere in the country. You can initially find out which plans do by clicking the "View Important Notes and Benefit Summary" link in the top-left menu on each plan details page. To confirm this information, check directly with the plan you select Before Enrolling in it, because some plans may allow this service for medical necessity only and not as a matter of convenience.

If you’re a snowbird or have any other reason to spend a large chunk of the year away from home in a particular place, you certainly need a drug plan you can use in both regions. So you probably want to search for pharmacies in both zip codes. If so, spare yourself a deal of confusion by saving your list of drugs when doing an initial search to find plans in your home area. Don’t Use your retrieval ID number to look at plans in the other zip code. Instead, enter your list of drugs all over again and save it a second time to get a different ID number. When the plan finder saves your original search, it automatically embeds the first zip code, along with the pharmacies located in that area. So if you use the same ID retrieval number for the other zip code, where pharmacies are different, the information can be distorted. For example, you may see a message saying, "You’ll pay 100% of the cost for drugs at this pharmacy because it is not in the plan’s network" — even if you haven’t selected a particular pharmacy. Creating a second search prevents this confusion from happening.

Finding Personal Help to Compare Plans

Not everyone has a computer or access to the Internet. Not everyone is familiar or comfortable with online searches. And you know what? That’s a-okay. Don’t feel badly if you’ve glanced at the previous sections on navigating the Medicare Prescription Drug Plan Finder and think "she may as well have written in hieroglyphics." You can find the same information by getting help from a live person.

Yes, at this point it may seem easier to choose a Part D plan by one of the unwise methods I mention earlier in this chapter — you know, signing up for the same plan as your spouse, opting for a plan with a well-known name, or listening to a sales pitch. But don’t go wobbly on me now.

The whole point of this chapter is to help you find the plan that’s best for You — the one that covers Your Drugs at the lowest cost. So don’t be put off when I say the plan finder is the most efficient way of getting there. The following sections list people you can turn to for help.

Asking family or friends for assistance

You may not be into computers, but I’m willing to bet someone in your family or circle of friends is. And, no matter how antsy you feel about asking for help, finding the right Part D plan is an excellent reason to do just that.

Maybe you have teenage grandchildren who are whizzes at electronics — and wouldn’t they be thrilled if you asked them to help! Never underestimate the ability of youngsters to pick their way through a complicated database without turning a hair. They’ve grown up with this stuff and know perfectly well that they’re more expert than you. (Even folks nifty on computers dread the day when their last child leaves home, depriving them of on-the-spot tech support.) Some families now make the process of helping their older members pick a Medicare prescription drug plan for the following year into an annual event. Lucky coincidence that Thanksgiving falls slap in the middle of the Part D open enrollment period, eh?

Of course, you don’t want to pitch even your favorite relative or best friend into the Medicare Prescription Drug Plan finder cold turkey — especially at Thanksgiving! Fortunately you can help her out. Give her your list of prescription drugs and the previous sections of this chapter to read and let her take it from there. After she finds a shortlist of two or three likely plans and prints them out, you can compare the options to make your final pick . . . for this year anyway.

Seeking help from professionals

By professionals I don’t mean people who are necessarily making a whole career out of giving Part D advice. I mean people who are trained to help, whether they’re being paid or they’re volunteering. By contacting any of the following three services, you can talk to someone who can use the plan finder to identify a Part D plan that suits you — and, best of all, the services don’t cost you a penny.

Calling the Medicare help line

You can call the official Medicare help line toll-free at 800-633-4227 (or 877-486-2048 for TDD users with impaired hearing) and ask a customer representative to find the two or three plans that best meet your needs and to mail printouts of their details to you. The rep just needs to know your Medicare ID number, your zip code, and the names of the prescription drugs you take, plus their dosages and how often you take them. Remember, making an accurate list of your drugs is essential. Flip to the section titled "Creating an accurate list of your meds" for help organizing this crucial information.

How helpful is the help line? Medicare uses contracted workers as customer representatives and gives them basic training, though their knowledge of Part D isn’t extensive. Feedback from consumers (and others who call the number to test the quality of the service) is mixed, as you may expect. Some callers get through to a rep in a jiffy; others remain on hold for ten minutes, or much longer. Some are satisfied with the information they receive; others aren’t.

So when you’re looking to find a Part D plan, it helps to be as specific as possible. Use the following steps to explain what you want:

1. Tell the rep whether you’re looking for drug coverage through a stand-alone prescription drug plan (PDP), a Medicare Advantage plan (MAPD), or a Special Needs Plan (SNP), as explained in Chapter 9.

2. Ask the rep to run a plan search using the details of your prescribed drugs — without substituting generics for them at this stage.

3. Tell the rep whether you qualify for Extra Help.

If you’re eligible for Full Extra Help (as explained in Chapter 5), say whether you want a plan that doesn’t charge a premium, or whether you’re prepared to pay part of the premium for a plan that may suit you better.

4. Ask the rep to do an initial search for the least expensive plans that cover your drugs Before Talking about pharmacy preferences or ways to lower your drug costs.

5. When the rep has completed this initial search and has a shortlist of possible plans, ask him to check whether each plan

A. Covers all your drugs

B. Places any restrictions (prior authorization, quantity limits, or step therapy — see Chapter 4) on any of your drugs

C. Has in-network pharmacies that are convenient to you

D. Offers a mail-order service that covers 90-day supplies of your drugs (if this option is important to you)

E. Covers your prescriptions at its network pharmacies in all 50 states and/or the territories (if this option is important to you)

6. Ask the rep to check the mail-order prices of your drugs in several plans to see whether these prices generate more savings.

7. Ask the rep to check whether you can reduce your expenses by using lower-cost drugs in each plan on the shortlist and, if so, by how much.

8. Ask the rep to mail you printouts of the three plans that best meet your needs.

The printouts should include full details of mail-order service, a list of each plan’s network pharmacies in your area, and details of the costs of lower-priced drugs in each plan. Ask the rep to confirm that these details are captured before mailing the printouts to you.

If the customer service rep refuses to give you all the info you ask for, ask to speak to the rep’s supervisor. You have a right to ask as many questions as you like to find a Part D plan that suits your needs. If the rep gives the impression that finding a plan for you is tedious or taking too much time, you also have the right to complain.

When you receive the printouts, you can compare each plan to make a final choice by using the worksheet in Appendix A, if desired.

Calling your State Health Insurance Assistance Program

State Health Insurance Assistance Programs, called SHIPs, provide expert free counseling services — specifically for people in Medicare — in all 50 states, the District of Columbia, Puerto Rico, Guam, and the U. S. Virgin Islands. Nationwide, more than 12,000 SHIP counselors (mainly trained volunteers) assist more than 2 million people every year with a wide range of Medicare problems, including how to choose a Part D plan. Go to Appendix B to find contact information for your local SHIP.

When you call your SHIP, you can schedule a face-to-face meeting with a local counselor or arrange to talk over a toll-free phone line. If English isn’t your first language, you can ask to speak with someone who knows yours. A SHIP counseling session may resolve a comparatively simple situation quickly and can be especially valuable if your circumstances are complicated.

When helping you choose a Part D plan, the SHIP counselor needs to know

Iw The names of your drugs, their dosages, and how often you take them in order to search the plan finder

U* Whether you’re looking for drug coverage through a stand-alone prescription drug plan or a Medicare Advantage health plan

U" Whether you’re eligible for Extra Help

The counselor can also help you choose a Medicare Advantage plan or apply for Extra Help, if necessary.

Calling your Area Agency on Aging

Every state and U. S. territory has an Area Agency on Aging (AAA) that provides a multitude of local services for people age 60 and over, including assistance with Medicare issues. In many cases, local AAAs rely on the SHIPs, described in the preceding section, to provide counseling on Medicare and

Part D. But some have their own trained volunteers who can give personal help in finding a Part D plan.

Find the number of your local AAA by calling the national Eldercare Locator toll-free at 800-677-1116. Calls are accepted on weekdays from 9 a. m. to 8 p. m. Eastern time. You can speak with someone in one of 150 languages, including Spanish. For more information on local services, visit Www. eldercare. gov.

Taking advice from other sources

You may well be able to get advice on picking a Part D plan from a variety of other sources. For example, many people report that they turn to their doctors, pharmacists, and insurance agents. Others receive help at senior centers, seminars, and info sessions of many kinds. Others are turning to new Part D plan-finding businesses that are popping up on the Internet.

Which of these info distributors can you trust to find a plan that meets your personal needs? Essentially, when can you believe what you hear — and when should you be skeptical? Following are some rules of thumb that may help:

U Just because someone is a professional doesn’t necessarily mean he knows enough about Part D to be of use to you in picking a plan. Doctors and pharmacists are professionals in their own fields and may be absolutely terrific at their jobs. But unless they’re able to run your particular set of drugs through the plan finder to search for the plan that covers your drugs and costs you least, they can’t really help you.

U Insurance agents are also professionals, and many of them are very knowledgeable about Part D. Others aren’t, and some are paid high commissions to sell a particular Part D plan (as explained in Chapter 11). If you have an agent who’s handled other insurance for you in the past and whom you trust, you may naturally turn to him to find a Part D plan. However, you should ask whether he’s able to use the plan finder to search for your best bet. If not, going to someone who can may be wiser.

U People on Medicare are often invited to info sessions at senior centers, retirement communities, hotels, or other venues and offered help in finding a Part D plan. Some of these sessions are an excellent value — for example, the ones run by volunteers from SHIP or other consumer groups. These trained people either show you how to use the plan finder yourself or run the numbers for you to help you pick a plan.

Other sessions are basically sales pitches for a single insurance company, promoting only the Part D plans it sells. If you hear information that dwells on a plan rather than your personal needs — or someone tries to sign you up for a plan on the spot — consider that an immediate red flag. And if whoever’s sponsoring the session offers you dinner on the house or other freebies, get out of there fast! These sneaky hard-sell tactics are real, as are outright scams, but I give you the tools to avoid them in Chapter 11.

U Wherever an opportunity opens up, some entrepreneur steps in to fill it. So the number of enterprising businesses offering to find Part D plans for seniors, usually for a fee, really isn’t surprising. If these operations are legitimate, whether offered through the Internet or by mail, they rely on the Medicare plan finder for their results. And if the results are good, you may consider your money well spent. But as of this writing, these plan-finding businesses are too new to assess whether they’re all legitimate or whether at least some may involve a new type of scam. In any case, why pay for a service you can get for free from someone you know you can trust, such as a family member, friend, or SHIP counselor?

What were they thinking. . . when they created so

Many Part D plans?

Strangely enough, nobody expected there’d be so many Part D plans. In fact, members of Congress were uncertain whether enough private insurers would offer enough Part D plans to provide competition, especially in rural areas. Some insurance honchos even predicted that the industry wouldn’t be interested in offering Stand-alone plans — the kind that provide only drugs and no other healthcare — because such plans had never existed before and were regarded as unprofitable. (The chief executive officer of one leading insurance company went so far as to call stand-alones "a harebrained idea" that just wouldn’t fly.) So when the law was written in 2003, it included a clause allowing the federal government to provide its own fallback drug plan in any area where fewer than two private plans entered the market. In other words, Congress guaranteed that at least two drug plans would be available to everyone on Medicare.

At least two! How quaint that seems today, with at least 50 stand-alone plans and dozens of Medicare Advantage plans plying their wares in every locality. What happened? As it turned out, the insurance industry — drawn by large federal subsidies — saw Medicare prescription drug coverage as a money-making bonanza.

The result was much like the California Gold Rush of the mid-1800s, with scores of insurers scrambling to carve out their share of a huge new market. That’s how Medicare beneficiaries came to be confronted with a bewildering number of choices.

So will there always be so many plans? Some experts anticipate that over time the market will shake out, with only a few of the largest plans — those that have attracted the greatest number of enrollees — remaining in business. This scenario would reduce the choices but, with less competition, probably also increase enrollees’ costs. Another potential turnaround is if Congress reduces or eliminates federal subsidies to plans, causing many of them to pull out of Part D. And yet another possibility, favored by some members of Congress and health policy experts, is to simplify plan choices by standardizing their designs — limiting them to maybe ten different options, each provided by a number of insurers at varying costs — in the way that Medigap supplementary insurance works today. Meanwhile, until any of those scenarios happen (or some entirely different development occurs), it’s safe to say the days of a Part D plan plethora won’t be over anytime soon.

Chapter 11

In This Chapter

► Working with formula output and finding formula input

► Trying out formulas involving distance and temperature

► Applying the order of operations to formulas

Mathematical formula is a rule, comprised of different operations. A formula works and is true no matter how many times you use it. A formula is created either by observing something that repeats and writing down the pattern, or by doing some creative mathematical manipulations. For instance, Pythagoras observed that there is a relationship between the sides of a right triangle. Hence, the famous formula called the Pythagorean theorem. (Chapter 18 is completely devoted to Pythagoras’s contribution.)

In this chapter, you see how to handle, manipulate, and come to terms with different types of formulas. The mathematical computations must be done correctly, so I cover that here. Plugging values into a formula nets the formula output or result, but you’ll also see how to determine what input gave you a particular output.

Solving for the Formula Amount

Working with a formula requires that you have the formula written accurately, that you know what the symbols in the formula represent (so you can put the right numbers in the right places), and that you do the mathematics correctly. You should also make a prediction or plan ahead so that you have a fairly good idea of what the answer will be. This helps you spot an obvious error in computations, if it occurs.

Inserting the values correctly for area and perimeter formulas

The formula for the area of a rectangle is A = Iw. Interpreting the symbols and operation, this formula says that the area of a rectangle, A, Is equal to the product of the length of the rectangle, L, And the width of the rectangle, W.

The Problem: Find the area of a rectangle with a length of 14 inches and a width of 7 inches.

The information in this problem is pretty straightforward. Let L = 14 and W = 7, and you get that the area is A = 14 x 7 = 98 square inches.

It’s nice when the values for a formula are laid out for you clearly. But sometimes you have to work out the details from pictures or charts. A Trapezoid Is a four-sided polygon in which one pair of opposite sides is parallel. The

Formula for the area of a trapezoid is A = ^ H _b 1 + b 2). Figure 10-1 shows you

The sketch of a trapezoid with segments labeled by size. The formula for the area of a trapezoid says that the area is equal to >2 times the height of the trapezoid times the sum of the two bases (the parallel sides). The height of a trapezoid is the distance between the two bases.

Figure 10-1:

A trapezoid is a special type of quadrilateral.

3 inches

4 inches

2 inches

5 inches

6 inches

The Problem: Find the area of the trapezoid pictured in Figure 10-1 using the dimensions shown in the figure.

First, identify the values that correspond to the different letters in the formula. Then replace the letters with the numbers and simplify the expression. In the trapezoid in Figure 10-1, the height of the trapezoid is 2 inches. The two bases are 4 inches and 6 inches in length. The other two lengths — the sides — aren’t needed to find the area of the trapezoid. Filling in the

Numbers, the area problem becomes A = ^(2)(4 + 6) = 1 (10) = 10 square inches.

If you were unhappy about not being able to use the lengths of the sides of the trapezoid in Figure 10-1, you need be unhappy no longer. The perimeter (distance around the outside) of a trapezoid is found with P = s1 + S2 + S3 + s4. The formula for the perimeter of a trapezoid isn’t very elegant, because the lengths of the sides are often all different. you don’t see pairs of lengths as in rectangles and parallelograms. But the formula for the perimeter of a trapezoid really just defines what the perimeter of any figure is: the distance around the outside.

The Problem: Find the perimeter of the trapezoid in Figure 10-1.

M\ Replace the side symbols in the formula with the measures of the sides. Do W \-7 1 not use the height of the trapezoid. So P = 3 + 4 + 5 + 6 = 18 inches.

When a polygon has some regularity to it — when opposite sides are parallel or the adjacent sides are congruent or some such situation — then the perimeter formula is more elegant than just adding up the measures of the sides. The perimeter formula can contain time-saving, computation-easing operations and groupings. The perimeter of a Parallelogram (a four-sided polygon with opposite sides that are parallel to one another) is found with P = 2(l + w). The perimeter is equal to twice the sum of the length and width. Figure 10-2 shows four parallelograms, all with the same perimeter. The first (left-most) parallelogram is just that — your standard, run-of-the-mill parallelogram. The second parallelogram is also called a Rhombus, A parallelogram with all the sides equal in measure. The next is a Rectangle, A parallelogram with 90-degree angles, and the last is the most special of all parallelograms, a Square.

Figure 10-2:

Four parallelograms all in a row.

2 3

The Problem: Find the perimeters of the parallelogram, rhombus, rectangle, and square from Figure 10-2 using P = 2(l + W) For the parallelogram and rectangle and P = 4S For the rhombus and square.

^VLA* First, identify the values of L, w, And S In the figures. Then replace the letters with the correct number values in the formulas and simplify. The L And W Represent the length and width of the parallelogram and rectangle. So the perimeter of each is P = 2(4 + 2) = 2(6) = 12 units. The letter S Represents the length of any side of the rhombus or square. So the perimeter of these two figures is P = 4(3) = 12 units.

4

3

3

Using the correct order of operations when simplifying formulas

Mathematical formulas are made up of symbols and operations. The operations need to be performed in the correct order so that you get the correct answer.

The Order of operations States that, when two or more operations are to be performed in a computation, you do the operations in the following order:

1. Powers or roots

2. Multiplication or division

3. Addition or subtraction

The Order of operations Is interrupted if you find grouping symbols. Operations inside parentheses or brackets or braces are performed before the results inside those grouping symbols are combined with other operations. Fraction lines also act as grouping symbols.

The Problem: The formula for finding the total amountnot f money in an

Account that earns compound interest is A = P ^ 1 + N J Where A Is the total

Amount of money that’s accumulated, P Is the principal or amount initially deposited, R Is the interest rate written as a decimal, N Is the number of times each year that the money in the account is compounded, and T Is the number of years that all this is occurring. Find the total amount of money in an account after 10 years if $15,000 is deposited and it earns 4.5 percent interest compounded quarterly.

^VLA/y Replace the letters in the formula with the corresponding numbers. The

Value of the expression inside the parentheses has to be computed first. But there’s both addition and division inside the parentheses, so do the division, and then add the results to the 1.

/ 045\4(10) A = 15,000 C1 + J

= 15,000 (1 + .01125)4(10) = 15^00 (L01125) ( )

Now the problem has multiplication, a power, and the power has a multiplication in it. Multiply the two numbers in the power. You don’t see a grouping symbol around those two numbers, but it’s implied — you have to combine them into one number before raising what’s in the parentheses to the power. (Use a calculator — unless you want to drive yourself crazy.) Then, for the last step, multiply by the number in front.

A = 15,000 (1.01125)40 15,000 (1.564377) = 23,465.65

The initial investment of $15,000 grew to over $23,000 in ten years.

The Problem: Heron’s formula is used to find the area of a triangle when all you have to work with are the measures of the three sides of that triangle.

Heron’s formula is A = (s — a)(s — b)(s — c) Where S Is the value of the

Semi-perimeter (half the perimeter) and a, B, And C Represent the lengths of the sides. Find the area of a triangle with sides that measure 7 yards, 18 feet, and 108 inches.

•aVLA/V First, notice that the measures are all different units. Change all the measures to the same unit. The best choice is to change everything to yards, because inches will result in some really big numbers. Also, the sides all come out to being a whole number of yards. The second step is to find the perimeter of the triangle. P = A + B + c. The semi-perimeter, S, Is half the perimeter. Then, finally, put all the values in their correct places in the formula and simplify.

Changing the measures, 18 feet is equal to 18 3 = 6 yards, because there are 3 feet in a yard. And 108 inches is equal to 108 36 = 3 yards, because there are 36 inches in a yard. The perimeter is: 7 + 6 + 3 = 16 yards. So the semi-perimeter is 8 yards (half the perimeter).

A = y8 (8 — 7)( 8 — 6)( 8 — 3)

Using the formula,,- ,— square yards. Note that,

= /8 2)(5) = 780 . 8.944

Using the order of operations, the subtractions inside the parentheses are done first, because the parentheses are grouping symbols. Then the results are multiplied. And, finally, the square root of the product is found.

One more named formula — one that all algebra students will recognize quickly — is the Quadratic formula. The quadratic formula is used to find the value of the unknown variable in a quadratic equation thAt’s writtEn in the

* 2 u A tu j * i • —b + /b2 — 4ac, .

Form Ax + Bx + C = 0. The quadratic formula is X =-^-where A Is

2A

The coefficient (multiplier) of the squared term in a quadratic equation, B Is the coefficient of the variable term raised to the first power, and C Is the value of the constant.

The Problem: Find the values of X That make the equation 12x – 31x + 20 = 0 a true statement.

^VLA/y Use the quadratic formula, letting A = 12, B = -31, and C = 20. First, simplify what’s under the radical, which acts as a grouping symbol. Do the power first, multiply the three terms together, then subtract the product from the power.

X

(— 31) + 7 (— 31)2 — 4 (12)( 20") 2 (12)

31 +961 — 960 31 +1

= – = -

24 24

31 + 1

= -

24

A quadratic equation can result in two different answers. Using the quadratic formula, the two answers are found by doing the addition and subtraction in the numerator and dividing by the denominator.

31 + 1

-—- zz

24

Or

Delving into a Formula and Its Input

A formula is used to find an answer to a problem that’s computable. You use one of several formulas to find the area of a triangle. The area is Predictable, Because the area of a triangle can be computed exactly using one of those

Formulas. The choice of a formula depends on what information or Input You have available. The Input Into a formula consists of numbers that are particular to that problem or question. For the area of a triangle, the input may be the length of the base and the height of the triangle, or the input may be the measures of the three sides. It all depends on the formula being applied that time.

Taking an answer and finding the question

Using the formula for the area of a square, you can find the area when you know how long the sides are. The formula for the area of a square is: A = S2 Where A Is the area and S Is the length of a side. This area formula also allows you to find the question if you’re given the answer. This is sort of like the game show Jeopardy!, Where you give the question.

The Problem: If the area of a square is 144 square inches, then what is the length of the sides of that square?

Replace the A In the formula with 144 and solve for the value of S. You get that 144 = s2. Two numbers have squares that are 144, 12 and -12. Because it doesn’t make any sense to have a side of a square be a negative number, then the answer must be S = 12.

The Problem: The area of a rectangle is found with the formula A = Lw, Where L Is the length and W Is the width. If the area of a rectangle is 70 square feet, and the length of the rectangle is 10 feet, then what is the perimeter of that rectangle?

This problem has two parts. First, you solve for the width of the rectangle. Then you use the length and width in the perimeter formula P = 2(l + W) To find the perimeter of that rectangle.

Since A = Lw, Replace the A With 70 and the L With 10. You get 70 = 10w. Dividing each side of the equation by 10, you get that W = 7. The width of the rectangle is 7 feet. Use this information to find the perimeter, replacing the L With 10 and the W With 7. The perimeter is found: P = 2(10 + 7) = 2(17) = 34 feet.

Consider a traveler who rents a car for $30 per day plus mileage. He returns the car after a few days and is shocked by the bill, so he asks about the charge for the mileage.

The Problem: Clay rented a car for three days. The contract reads that the charge is $30 per day plus mileage. The number where the mileage rate is given is all blurry. His total bill is $310, and he drove 400 miles, so what is the charge per mile?

^VLA/y The total charge was based on the formula: C = (rate X M) + ($30 X D). This formula says that the charge, C, Is equal to the mileage rate times the number of miles, M, Plus $30 times the number of days, D. Clay has all of the information he needs except for the rate per mile. Filling in the information that he has, Clay knows that $310 = (rate X 400 miles) + ($30 X 3 days). Letting the mileage rate be represented by R, The formula simplifies to: 310 = 400R + 90. Subtract 90 from each side to get that 220 = 400R. Divide each side by 400, and you get that R = 0.55. So it appears that the mileage rate was 55<t per mile.

Comparing several inputs resulting in the same output

You can reconstruct exactly what input resulted in a certain output as long as the formula contains just one input variable. For example, if the perimeter of a square is found with P = 4S, And you’re told that the perimeter is 48 yards, then solving 48 = 4S, You get that S, The length of the side of the square, is 12 yards. Reconstructing the input gets a bit more challenging when the formula contains two or more input variables.

The Problem: The area of a triangle is 20 square inches. If the lengths of the base and height are whole numbers, then what are the base and height of this triangle?

^.VLAiV The area of a triangle is found with the formula A = ^ Bh Where B Represents

The length of the base of the triangle, and H Represents the height of the trian-9W^s£. I Gle. (The height is drawn from the base up to the vertex of the triangle and is ^bJ>^ perpendicular to the base.) You find several possibilities for B And H That result in an area of 20 using the formula. Because the product of B And H Is being multiplied by >2, the product must be 40 before it’s multiplied. Table 10-1 shows the possibilities resulting in an area of 20. Remember: The base and height are whole numbers.

Each of the triangles given in the table has an area of 20 square inches. Figure 10-3 shows you three of the triangles as examples. Notice how different the shapes of the triangles are.

If you need to find out exactly which triangle the original 20 square inches came from, then you need more information about the triangle. For example, if you were told that the base was 6 inches longer than the height, then you know that the base of 10 inches and the height of 4 inches were the original input. In Chapter 13, you see how to write algebraic equations using this kind of additional information to solve problems.

The Pythagorean theorem is a formula saying that A2 + B2 = C2. The Pythagorean theorem gives the relationship between the three sides of a right triangle. The letters A And B Represent the lengths of the two shorter sides of a right triangle, and the letter C Represents the length of the Hypotenuse (the longest side, opposite the 90-degree angle) of a right triangle.

The Problem: What are the lengths of the two shorter sides of a right triangle if the hypotenuse is 25 cm? (You want only whole-number answers, no decimal approximations.)

Using the Pythagorean theorem and replacing the C With 25, you get that A2 + b2 = 252 = 625. You need to find two numbers such that the sum of their squares is 625. A table works well here (see Table 10-2). You solve for B In the original equation and put in numbers for A, Starting with 1 and working your way up. Solving for B, You get B = J625 — A2. As it turns out, there are four values of A That result in a perfect square under the radical and a nice value for B. The table just shows a few of the numbers that don’t work and then the numbers that do give a nice answer. Note: In the table, I refer to a Pythagorean triple, Which is a listing of three numbers that work in the Pythagorean theorem. They’re always whole numbers.

There are, of course, lots of not-so-nice answers that use decimal approximations. The answers listed here are the only ones that give whole-number measures for the sides of the triangles.

Going the Distance with Formulas

Distance is actually computed using several different formulas. The formula D = Rt Is used to find distance when you have the rate at which an object is moving and you know how long that object has moved. Another distance

Formula is D = J(x2 — xl) + _y2 — yl) , which is used to find the distance

Between two points graphed in a coordinate system. A third distance formula, S = -16t2 + Vot + So, Is actually a height formula, telling you how high something is after it travels for a period of time. You get to experience all three of these formulas here.

Distance, rate, and time are related to one another with a formula that says Distance = Rate x time. The distance is usually given in terms of miles or feet or inches. The rate is often in miles per hour, feet per second, or inches per year. And the time is in hours, minutes, seconds, or years. In any case, the D = Rt Formula is used to answer the questions: "How far have we gone?", "Can you step on it?", or, my all-time favorite from the kids sitting in the backseat, "Are we there yet?"

Solving for distance traveled

Depending on which distance formula you’re using, the input is quite different. One distance formula inputs the rate and time. The second distance formula inputs coordinates of points. And the third formula inputs just time. In all three cases, the output is a distance measure.

Distance is rate times time

When using the D = Rt Formula, you need to watch out for the units. If the rate is miles per hour, then you need to multiply by hours.

The Problem: How far has a car traveled if it averaged 40 mph for 234 Hours and then sped up to 55 mph for the next 45 minutes?

^VLAAf This problem involves two different distances that are added together — the first distance that’s traveled at 40 mph and the second distance that’s traveled

At 55 mph. The 45 minutes is changed to 45 = 3 hour. Computing the first

60 4

Distance, D = 40 mph X 2.5 hours = 100 miles. And the second distance is D = 55 miles per hour X 0.75 hours = 41.25 miles. Adding distances, 100 + 41.25 = 141.25 miles.

Multiplying miles per hour times hours or feet per second times seconds results in the distance because the fractions reduce, cancelling out units, as shown here.

, M Miles H Hours, ., D = ;» nmca # —^-= M # h Miles

Hour 1

. f Feet S Seconds

D =-—^r # —-= F # s Feet

Second 1

D = N Inches # Y Years = N # y Inches year 1

Crossing the bridge

During a war, there was a bridge between two countries that was heavily guarded on the east side. A sentry tower on the east side was manned 24 hours a day. Every three minutes, a guard would come out of the tower to check on the bridge. His orders were to turn back anyone who was trying to cross the bridge to come to

The east and to shoot anyone who was trying to get out of the country on the east and go to the west. A woman desperately wanted to get into the western country. She knew that it would take her five minutes to cross the bridge, but she managed to do it. How did she cross from the east to the west? (No, she didn’t swim.)

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The Problem: A glacier moves at the rate of 1.5 inches per month. How far does it travel in 20 years?

V£.?LA/v You can either change the inches per month to inches per year, using a proportion, or change 20 years to months and then use the formula. Instead of changing to a number of months, it’s probably preferable to stay with years. Changing 1.5 inches per month into inches per year, use the following proportion:

1.5 inches X Inches

1 month 12 months 1.5 (12) = X

18 = X

The glacier moves 18 inches in one year. Then find the distance with D = 18 inches per year x 20 years = 360 inches (which is 30 feet).

Finding the distance between two points

The formula for the distance between two points on a graph uses the X And the Y Coordinates of the points. You find the difference between the pairs of coordinates, square the differences, and add them together. Then take the square root of the sum. The distance is in terms of Units On the graph.

The Problem: A circle is sketched on graph paper, and the endpoints of the diameter of the circle are at the points (-4,7) and (2,-1). What is the length of the diameter of this circle?

Use the distance formula, D = J_ X2 — X 1) + _ Y 2 — Y 1) , to find the distance

Between the points. Put the first point’s coordinates in where the subscripts are 1s and the second point where the subscripts are 2s.

D = / (2 — (— 4))2 + (—1 — 7)2 = / 62 + (— 8)2 = /36 + 64 = 7100 = 10

The diameter is 10 units long.

Finding the height of the ball

When a ball is tossed into the air, it has an Initial velocity (the speed it’s traveling at the very beginning) that slows down after time because of the pull of gravity. The formula for the height of an object after a certain amount of time, T, Is S = -16t2 + Vot + So Where S Is the height of the object, -16t2 represents the effects of the pull of gravity after T Amount of time, VO is the initial velocity, and SO is the initial height of the object.

The Problem: How high is a baseball 5 seconds after it’s hurled straight up into the air by a pitching machine if the ball is, at first, traveling at 100 mph and the pitching machine is sitting on the top of a building 30 feet up in the air?

Figure 10-4:

I shot a ball into the air; it landed I know not where.

\1

^VLA/V The units in this problem are all over the place. The question involves seconds; the rate is in miles and hours; and one of the dimensions is in feet. First, change everything to seconds and feet. Then use the formula for the height. To change the miles per hour to feet per second, multiply miles per hour x hour per seconds x feet per mile. Notice how the units cancel to give you the rate you want.

1 mile = 5,280 feet and 1 hour = 60 x 60 = 3,600 seconds

100 miles

1 hour

5,280 feet

1 hour 3,600 seconds 1 mile

100 X 1 X 5,280 feet = 528,000 feet " 1 X 3,600 X 1 second

528,0Q0 = 5,280 " 3,600

3,600 seconds

3680 = 146 3 feet/second

The rate is about 146.67 feet per second. Substituting all the information into the formula for the height, S = -16(5)2 + 146.67(5) + 30 = -400 + 733.35 + 30 = 363.35 feet. After 5 seconds, the ball is 363.35 feet in the air. In case you’ve ever considered taking calculus, here’s some further encouragement. In this problem, calculus tells you that this ball is on its way back down after reaching its highest point when T Was equal to about 4.5 seconds. Now, don’t you want to know more — and what else calculus can do for you?

VLAiV

Solving for rate or time

The distance formula, D = Rt Gives you the distance traveled when you know how fast you’re traveling and how long it’s been since you started. With some simple algebraic manipulations, you change the formula into a new formula that gives you the speed when you have the distance and time, or you change the formula to one that gives you time when you’re given the distance and rate.

The following formulas are all derived from one another:

D = Rt, r = D, T = D

The Problem: Your friend shows up at your doorstep at 2 a. m. with baggage in hand. He left Boston, 1,200 miles away, at 6 a. m. yesterday morning. How fast was he traveling (what was his average rate of speed)?

Solve for the rate using R = y. Determine how many hours there are between

6 a. m. and 2 a. m. the next day and divide the distance by that number of hours. The easiest way to figure the number of hours is to just say that the amount of time was 4 hours short of a whole day. Subtract 4 from 24, and you get that he

. ,J( ,nu N,■ ,u . 1,200 miles 1,200

Traveled for 20 hours. Computing the rate, R = OA ,-= Nrl

, v & 20 hours 20

Per hour.

60 miles

The Problem: During that fabled race between the tortoise and the hare, a ladybug was clinging to the back of the tortoise for the first 0.2 mile. The tortoise lumbered along at 3 feet per minute. As the hare passed by the tortoise, the ladybug jumped onto the neck of the hare and traveled for the next 0.3 mile of the race at a rate of 50 feet per minute, until the hare decided to take a nap. How long did the ladybug get to travel on these two racers before nap time took over?

Find the two different times and add them together. The time that the lady-bug spent on the tortoise is found by dividing 0.2 mile by 3 feet per minute. Of course, first, the miles have to be changed to feet. Then find the amount of time on the hare by dividing 0.3 mile by 50 feet per minute. Add the two times together.

Changing 0.2 mile and 0.3 mile to feet, use the fact that 1 mile = 5,280 feet. 0.2 mile _ X Feet 0.3 mile _ X Feet

1 mile 5,280 feet 0.2 (5,280) = X 1,056 = X

1 mile 5,280 feet 0.2 (5,280) = X 1,584 = X

Now use the formula T = -=- to solve for the two times.

T=

1,056 feet _ 3 feet/sec.

352 sec.; T

1,584 feet , 50 feet/sec.

31.68 sec.

Adding the times together, 352 + 31.68 = 383.68 seconds. This is about 6.39 minutes. What a ride!

The distance formula S = -16T2 + VOT + SO Gives you the height of an object when you know how much time has elapsed. You determine the input, the amount of time, by solving the quadratic equation for T.

The Problem: A toy rocket is shot into the air at 144 feet per second from the top of a platform that’s 2 feet high. How long does it take for the rocket to reach a height of 130 feet?

Divided by the mighty Mississippi

The Mississippi River is the dividing line Mississippi River, where the distance between between Tennessee and Arkansas. If an air- the two banks is exactly the same, then where plane crashed exactly in the middle ofthe would the survivors be buried?

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^VLA* Using the formula, and filling in 130 for S, 144 for Vo, And 2 for So, The equation becomes 130 = -16t2 + 144t + 8. Subtract 130 from each side of the equation, and you get the quadratic equation 0 = -16t2 + 144t – 128. This equation factors into 0 = -16(t2 – 9t + = -16(t-1)(t-8). Setting the two binomial factors equal to 0, you get that T = 1 or T = 8. The question is: How long does it take for the rocket to reach 130 feet? The answer is that it only takes 1 second. It then goes higher until it turns back down toward the ground. At 8 seconds after launching, the rocket is back down to 130 feet and eventually hits the ground (assuming there’s no parachute attached).

Testing the Temperature of Your Surroundings

Temperature is an important measure to everyone. When the snow is falling and the wind blowing, it’s much too cold. When the sun is blazing and the air not stirring, it’s too hot. If you want your pie to bake to a perfect golden brown, you need the right setting on your oven. And if that isn’t enough, more challenges arise when the thermometer is scaled in degrees Celsius instead of Fahrenheit — or vice versa, depending on your choice of measure.

Changing from Fahrenheit to Celsius

The Fahrenheit temperature scale registers freezing at 32°F and boiling at 212°F, a difference of 180°. The Celsius scale (also called Centigrade) Has freezing at 0°C and boiling at 100°C, a difference of 100°. The ratios of 180:100 and 100:180 are what make up a major part of the formulas for changing from one temperature to another. The formula for converting Fahrenheit temperatures

To Celsius temperatures is °C = 9 (°F — 32°). To figure out what the Celsius

Temperature is, you subtract 32° from the Fahrenheit temperature and

Multiply by 5. The fraction comes from reducing i00 — one of the ratios. 9 180

The Problem: A good friend of yours lives in England, and, when you told her that it was 104° outside yesterday, she gasped and said that it just couldn’t be. You remembered that she uses the Celsius system, so you converted the temperature to one that she is more accustomed to. What new temperature did you give her?

Use the formula for changing from Fahrenheit to Celsius. °C = 9 (104° — 32°) = 59

9 (72°) = 40°. You changed the temperature to 40°, and she was satisfied.

Changing from Celsius to Fahrenheit

The formula for changing a Celsius temperature to a Fahrenheit temperature is °F = 9 (°C) + 32°. Notice that you first multiply the Celsius measure by the fraction and then add 32°.

The Problem: You’re planning a trip to Germany and read that the expected temperature for the week of your visit is 25°. You pack a heavy coat and woolen mittens and lots of sweaters. Is this a mistake?

^VLA* Change the Celsius temperature to Fahrenheit. °F = 9 (25°) + 32° =

45° + 32° = 77°. It’s going to be a balmy 77°. You’re way overdressed and you’re too warm in your winter clothes.

The Problem: What temperature in degrees Fahrenheit is the same temperature in degrees Celsius?

^VLA/V You want °C = °F, so replace one of the sides of the equation with its conversion formula. Replacing the °F with its conversion equivalence, you get an

Equation that’s solved by subtracting 9 C From both sides and then multiply -

45

Ing both sides by the reciprocal of — 4.

5

°C= °F

C = 5 C + 32

— 5 C = 32 C =—40

A temperature of -40°C = -40°F. This temperature is the only one that’s the same in both scales.

Cooling off with Newton’s Law

Newton’s Law of Cooling says that the greater the difference in temperature of an object is from its surroundings, the more quickly the object’s temperature will change toward the surrounding temperature. For instance, when you pour a cup of hot coffee and set it on the counter in a room that’s 72°F, the coffee cools off much faster during the first few minutes than it does as it gets closer to the temperature of the room. This is the same with heating (opposite of cooling). Have you ever waited impatiently for that turkey to finish cooking on Thanksgiving day? The last couple of degrees on the thermometer always seem to take the longest — and they do!

The formula for Newton’s Law of Cooling is: T (t) = Ta + (To - Ta) e~kt Where T Is the temperature of the object after the amount of time T, Ta Is the temperature of the environment or room, TO is the original temperature of the object, and the multiplier E~kt Has the number E Which is about 2.71828 and the constant K Which changes, depending on the density of the object.

The Problem: You’ve just cooked your pizza in a 450°F oven. You take it out and set it in a room that’s 72°F. For the density of this pizza, the constant, K, In Newton’s Law of Cooling is 0.0843. What will the temperature of your pizza be after five minutes? Will it be cool enough to eat?

^VLA* Using Newton’s Law of Cooling, let the temperature, T, Be 5, the initial temperature of the pizza be 450°F, the temperature of the environment be 72°F, and the value of K = 0.0843. Replacing all the letters in the formula with these numbers and simplifying, you get:

T (5) = 72 + (450 — 72) e~(00843,(5)

= 72 + 378e-04215= 72 + 247.991 = 319.991

At about 320°F, this is still too hot to eat.

Part III

Linear

Trigonal planar

109.5°

Tetrahedral

Trigonal pyramidal

Bent (V shaped)

Figure 5-11:

Molecular shapes predicted by VSEPR theory.

Trigonal bipyramidal

Seesaw

T-shaped

Octahedral

Square pyramidal

Square planar

Figure 5-12:

The electron configuration of carbon.

T t

1s 2s

2p

C

How can hydrogen atoms form four identical bonds with carbon? Conceptually, two things happen to produce the four equivalent orbitals necessary for methane.

First, one of carbon’s 2s electrons is "promoted" (sent to a higher-energy orbital) to the empty 2p orbital. This promotion results in four half-filled valence orbitals; the 2s orbital and three 2P Orbitals now each contain one electron.

Second, the single 2s orbital is mixed with the three 2p orbitals to create four identical Sp3 Hybrid orbitals. The fact that each Sp3 Orbital is identical is important because VSEPR theory can now explain the symmetrical shape of methane: the tetrahedron.

So, the shapes of real molecules emerge from the geometry of valence orbitals — the orbitals that bond to other atoms. Here’s how to predict this geometry:

1. Count the number of lone pairs and bonding partners an atom actually has within a molecule. You can do this by looking at the Lewis structure.

In formaldehyde (CH2O), for example, carbon bonds with two hydrogen atoms and double bonds with one oxygen atom. So, carbon effectively has three valence orbitals.

2. Next, inspect the electron configuration, looking for the mixture of orbital types (like s and P) That the valence electrons occupy.

Carbon has four valence electrons in 2S22P2 Configuration. Two valence electrons occupy an S Orbital, and one electron occupies each of two identical P Orbitals. The S Orbital isn’t equivalent to the P Orbitals. So, we mix the S Orbital with the two P Orbitals to create three identical Sp2 Hybrid orbitals.

Note that the total number of orbitals doesn’t change; in the example, formaldehyde has three valence orbitals before mixing and still has three valence orbitals after mixing. VSEPR theory predicts that electrons in three identical orbitals mutually repel to create a Trigonal planar geometry — the three orbitals splay out in a plane with 120 degrees between each orbital. The shape of the formaldehyde molecule is trigonal planar.

Different combinations of orbitals produce different hybrids. One S Orbital mixes with two P Orbitals to create three identical Sp2 Hybrids. One S Orbital mixes with one P Orbital to create two identical Sp Hybrids. Centers with Sp3, sp2, And Sp Hybridization tend to possess tetrahe-dral, trigonal planar, and linear shapes, respectively.

Lewis structures provide a good starting place for roughly estimating the shapes of molecules.

If a central atom has two bonding partners, the shape of the molecule around that center will likely be fairly linear.

If the central atom has three bonding partners, the shape will likely be close to trigonal planar.

If the central atom has four bonding partners, the shape will likely be close to tetrahedral.

The actual shapes may vary from these rough estimates depending on other factors, such as whether the central atom has lone pairs. For example, the oxygen atom of water has two lone pairs in addition to two bonding orbitals. In all, then, the electrons in the orbitals surrounding oxygen create a tetrahedral-like Geometry. But, because only two hydrogen atoms are actually bound, the shape of the Molecule Is "bent."

Q. Methane, CH4, has four hydrogen atoms bonded to a central carbon atom. Ammonia, NH3, has three hydrogen atoms bonded to a central nitrogen atom. Using VSEPR theory, compare and contrast the Orbital geometry And Molecular shape Of these two molecules.

A. Carbon and nitrogen are both Sp3

Hybridized in methane and ammonia, respectively. Carbon contributes a single electron in each hybrid orbital to a cova-lent bond, the second electron in each bond coming from a hydrogen. Nitrogen has one more valence electron than

Carbon. Therefore, one of the hybrid orbitals of nitrogen contains two electrons and can’t receive a bonding electron from hydrogen. Although ammonia has only three bonded hydrogen atoms for this reason, the central nitrogen has a lone pair of electrons in the remaining sp3 orbital. These electrons still repel other electron pairs. So, the ammonia molecule has a nearly tetrahedral orbital geometry, similar to that of methane. However, because one of the orbitals contains a lone pair (not a bonded atom) the molecular shape of ammonia is trigonal pyramidal.

12. What’s the hybridization of carbon in carbon dioxide (CO2)? In formaldehyde (CH2O)? In methyl bromide (H3CBr)?

Solve It

13. Use Lewis structures and VSEPR theory to predict the shape of water (H2O), ethyne (C2H2), and carbon tetrachloride (CCl4).

Solve It

14. Chlorine trifluoride (ClF3) is a T-shaped molecule with trigonal bipyramidal orbital geometry. How is the T shape possible?

Solve It

Answers to Questions on Bonds

See how well you’ve bonded to the concepts in this chapter. Check your answers to find out if they overlap with the ones provided here. If not, take another orbit through the questions.

D Potassium (K) transfers its single valence electron to fluorine (F), yielding an ionic bond between K+ and F-, as shown in the following figure:

K

K + : F

CM Two lithium atoms each transfer a single electron to one sulfur atom To yield the ionic compound, Li2S. As a group IA metal, lithium easily gives up its single valence electron. As a group VIA nonmetal, sulfur readily accepts two additional electrons into its valence shell.

CM As a salt, magnesium chloride (MgCl2) is certainly an ionic compound. So, MgCl2 dissolves to a greater extent in more polar solvents. Dissolved ions act as Electrolytes, Conducting electricity in solutions. The more brightly glowing bulb in the circuit containing the aqueous (water-based) solution suggests that more electrolytes are present in that solution. More salt dissolved in water than in rubbing alcohol because water is the more polar solvent.

CM Dichlorine is Cl2, a compound formed when one chlorine atom bonds to another. Because each atom in the compound is of the same element, the two atoms have the same electronegativity. So, the difference in electronegativity between the two atoms is 0. This means that the bond between the two chlorine atoms must be covalent. The electron dot structure of dichlorine is shown in the following figure:

• • • •

: Cl; Cl:

• • • •

CM A Coordinate covalent bond Forms between the aluminum and the hydrating water molecules. Aluminum is a group IIIA element, so the aluminum (III) cation formally has no valence electrons. The oxygen of water has lone pairs. So, water molecules most likely hydrate the cation by donating lone pairs to form coordinate covalent bonds. In this respect, we can call the water molecules ligands of the metal ion.

CM Resonance structures for benzene are shown in the following figure. Adjacent carbons in the ring are held together with either single or double covalent bonds depending on the resonance structure. So, in the resonance hybrid structure, each carbon-carbon bond is identical, and is neither a single bond nor a double bond, but something more like a one-and-a-half bond.

H

HCH

H

CC HCH

C

C

H

H

The molecular orbital diagram for dihelium is shown in the following figure. Each helium atom contributes two electrons to the molecular orbitals for a total of four electrons. Each molecular orbital holds two electrons, so both the low-energy bonding orbital and the high-energy anti-bonding orbitals are filled.

He2 antibonding

He:

He

Energy

<Z2>

He2 bonding

The total energy change to make dihelium from two separate helium atoms is the sum of the changes due to bonding and antibonding. Putting two electrons in the antibonding orbital costs more energy than is saved by putting two electrons in the bonding orbital. So, going from two separate helium atoms to one molecule of dihelium requires an input of energy. Reactions spontaneously go to lower energy, not higher energy, so dihelium is unlikely to exist under normal conditions.

The reaction breaks one of the carbon-carbon bonds, replacing the double bond with two single bonds. The carbon-carbon bond that breaks is the pi bond, because the pi electrons are more accessible (above and below the axis of the bond) and because the pi bond is weaker than the sigma bond. So, the weaker pi bond is replaced by a stronger sigma bond. In bonds, Weaker Means higher energy, and Stronger Means lower energy. So, the reaction moves from higher to lower energy, which is favorable.

The assignment of bond character depends on the difference in electronegativity between the atoms:

A. The difference in electronegativity between H and Cl is 0.9, so the bond is a Polar covalent bond.

B. The difference in electronegativity between Ga and Ge is 0.2, so the bond is a Nonpolar covalent bond.

C. The difference in electronegativity between O and O is 0.0, so the bond is a Nonpolar covalent bond.

D. The difference in electronegativity between Na and Cl is 2.1, so the bond is an Ionic bond.

E. The difference in electronegativity between C and O is 1.0, so the bond is a Polar covalent bond.

III Both molecules contain polar covalent bonds. The C-F bonds of CF4 are slightly more polar than the H-O bonds of water due to the greater difference in electronegativity between the former pair of atoms (1.5 versus 1.4). However, water is a much more polar molecule due to molecular shape. Because of its tetrahedral shape, the bond dipoles of CF4 cancel each other out entirely, so the molecule as a whole is nonpolar. Because of its bent shape, the bond dipoles of water only partially cancel, so the molecule as a whole is polar.

U In CO2, carbon is Sp Hybridized. CO2 is linear, with the carbon double-bonded to each oxygen so that four electrons are constrained in each of two bond axes. In CH2O, carbon is Sp2 Hybridized, so the molecule is trigonal planar. The four electrons of the double bond are constrained within one bond axis, and two electrons each are within bonds to hydrogen. In H3CBr, carbon is Sp3 Hybridized, so the molecule is shaped like a tetrahedron, similar to the shape of methane, CH4; Each bond is separated from all the others by approximately 109 degrees. Two electrons are constrained within each of four bonds.

Mi The Lewis structures for the three molecules are shown in the following figure. The oxygen of water is sp3 hybridized, with two single bonds and two lone pairs, resulting in a bent shape. Each carbon of ethyne is Sp Hybridized, with six electrons devoted to a triple bond and two devoted to a single bond with hydrogen, resulting in a linear shape. Carbon tetrachloride is Sp3 Hybridized, with all electron pairs involved in single bonds, resulting in a tetrahedral shape.

*O*

/ \ HH

H — C = C — H

Cl I

Cl— C —Cl

I

Cl

Ufl The hybridization of an atom’s valence orbitals determines that atom’s orbital geometry, but doesn’t completely determine molecular shape. Shape depends on whether electrons in the orbitals are involved in bonding or in lone pairs. Trigonal bipyramidal geometry suggests that there are five valence orbitals: two along a central axis and three distributed evenly in a plane perpendicular to that axis (it may help to refer back to Figure 5-10). In ClF3, Cl is the central atom. Both orbitals along the central axis are involved in Cl-F bonds to fluorine atoms. Only one of the orbitals in the perpendicular plane is involved in a bond to the remaining fluorine atom. The other two orbitals contain lone pairs. The result is a T-shaped molecule.

In This Chapter

^ The role of attention in overcoming emotional problems ^ Concentrating on tasks ^ Directing and redirecting your attention Practising mindfulness

Traditionally, CBT has tended to concentrate many of its techniques on helping people change the Content Of their thinking – from a negative to a more realistic thought, for example. However, modern CBT has begun to incorporate another area of human psychology – how we focus our attention.

This chapter does not discuss What You think, but does discuss How You manage your thoughts and attention. We introduce Task concentration training And Mindfulness, Two techniques for managing problematic thoughts and exerting some power over your attention. This chapter has two main messages:

For the most part, your thoughts, no matter how distressing and negative, are not the real problem. Rather, the importance or meaning you attach to those thoughts is what causes you the problem. If you view the notion, ‘I’m a hopeless case’, as a thought rather than a fact, you can greatly lessen its impact.

When you have an emotional problem, your mind tends to attach unhelpful meanings to aspects of yourself, the world around you, and other people. You can also tend to Overfocus On particular aspects of these unhelpful meanings. Fortunately, you can develop the ability to steer your attention towards, and away from, any features of your experience you choose, which can help improve your mood and reduce anxiety.

Training in Task Concentration

Becoming adept at redirecting your attention away from yourself (this includes your bodily sensations, thoughts, and mental images), in certain situations, is the essence of Task concentration. Rather than thinking about yourself, you focus your attention towards your external environment and what you’re doing.

Task concentration involves paying less attention to what’s going on Inside Of you and more attention to what’s happening Outside Of you.

Task concentration can be particularly useful in situations that trigger anxiety. Task concentration can help you to counterbalance your tendency to focus on threats and on yourself when you feel anxious.

As you begin to practise task concentration, break down the process into two rehearsal arenas – just as when learning to drive you begin on quiet roads and eventually advance on to busier roads.

The two rehearsal arenas are as follows:

Non-threatening situations: Here, you typically experience little or no anxiety. For example, if you have social phobia, you may feel little anxiety walking through a park, travelling on a very quiet train, or socialising with family members and close friends.

More challenging situations: Here, you tend to experience moderate to severe anxiety. More challenging situations may include shopping in a busy grocery store, travelling on a train during rush hour, or attending a party with many guests whom you do not know.

Typically, you gradually progress from moderately threatening situations to more challenging situations as you practise and develop greater skill.

First, practise redirecting your attention in situations you regard as relatively non-threatening, then you can move on to using the techniques in increasingly challenging situations.

Choosing to concentrate

The point of task-concentration exercises is not to lessen your overall concentration, but to concentrate harder on different aspects of the external environment. Some tasks require you to focus your attention on certain

Behaviours – such as listening to what another person is saying during a conversation, or attempting to balance a tray of drinks as you walk through a crowded room.

In other situations, you may feel anxious but you don’t have a specific task to attend to. In such a situation, for example, while sitting in a crowded waiting room, you can direct your attention to your surroundings, noticing other people, the features of the room, sounds, and smells.

With practice, you can be both task – and environment-focused rather than self-focused, even in situations that you regard as highly threatening.

The following exercises aim to increase your understanding of how paying attention to sensations and images limits your ability to process information around you. The exercises will also help you realise that you can attend to external task-related behaviours. In other words, you can master Choosing What you pay attention to in situations when your anxiety is triggered.

Intentionally directing your attention away from yourself does not mean Distracting Yourself from your physical sensations or suppressing your thoughts. Sometimes, people try to use thought suppression as a means of alleviating uncomfortable sensations and anxiety. However, suppression usually works only briefly, if at all.

Concentration exercise: Listening

For this exercise, sit back-to-back with someone else, perhaps a friend or your therapist. Ask the person to tell you a story for about two minutes. Concentrate on the story. Then, summarise the story: Note how much of your attention you directed towards the task of listening to the other person, towards yourself, and towards your environment during the exercise – try using percentages to do this. Your partner can give you feedback on your summary to give you some idea of how accurate your summary is.

Now do the exercise again, but this time round sit face-to-face with the storyteller and make eye contact. Ask the person to tell you a story, but on this occasion deliberately distract yourself by focusing on your thoughts and sensations, and then redirect your attention towards the storyteller. Summarise the story, and note (using percentages again) how you divided your attention between yourself, listening to the other person, and your environment.

Repeat the storytelling activities, sitting back-to-back and thenface-to-face, several times until you become readily able to redirect your attention to the task of listening after deliberate distraction through self-focusing. Doing so helps you to develop your ability to control where you focus your attention.

Concentration exercise: Speaking

Follow the same steps for this speaking exercise as you do for the listening exercise, as we describe in the preceding section. Starting with your back to the back of the other person, tell a two-minute story, focusing your attention on making your story clear to the listener.

Next, position yourself face-to-face with the listener, making eye contact. Deliberately distract yourself from the task of storytelling by focusing on your feelings, sensations, and thoughts. Then, refocus your attention towards what you’re saying and towards the listener, being aware of her reactions and whether she understands you.

Again, using percentages, monitor how you divide your attention among yourself, the task, and your environment.

Concentration exercise: Graded practice

For this exercise, prepare two lists of situations. For your first list, write down five or so examples of situations you find non-threatening. Practise distracting yourself (by focusing on your internal sensations and thoughts) and then refocus your attention onto external things in these non-threatening situations. For your second list, write down ten or so examples of situations you find threatening. Arrange the situations in a hierarchy, starting from the least anxiety-provoking and graduating up to the most anxiety-provoking. Now work through your hierarchy by deliberately entering situations, while practising task concentration until you reach the top of your list. This means you start to practice mastering your anxiety in real-life situations.

Concentration exercise: Taking a Walk

For this exercise, walk through a park, paying attention to what you hear, see, feel, and smell. Focus your attention for a few minutes on different aspects of the world around you. First, focus your attention mainly on what you can hear. Then shift your attention to focus on smells, and then on to the feel of your feet on the ground, and so on. You can move your attention around to different sensations, which can help you tune your attention into the outside world.

After you’ve practised directing most of your attention to individual senses, try to integrate your attention to include all aspects of the park. Try to do this for at least 20 minutes. Really let yourself drink in the detail of your surroundings. Discover what hooks your attention. You may be drawn to water

Or have a keen interest in birds, plants, or perhaps even woodland smells. Notice how you feel much more relaxed and less self-conscious as you train your attention on the world around you.

Tuning in to tasks and the World around you

If you’re suffering from anxiety, you’re probably self-focused in social situations and fail to notice the rest of the world. On top of feeling unnecessarily uncomfortable, your self-focus means that you’re likely to miss out on a lot of interesting stuff. Luckily, you can change your attention bias and overcome much of your anxiety.

You can also use your re-training attention to help prevent yourself from engaging with the stream of negative thoughts that accompanies depression, which will in turn help you lift your mood.

Here’s an example of how you can use task-concentration techniques to overcome anxiety, specifically social phobia (see Chapter 9 for more on social phobia).

Harold was particularly worried that people would notice that he blushed and sweated in social situations. He believed that people would think he was odd or a nervous wreck. Harold constantly self-monitored for blushing and sweating and tried very hard to mask these symptoms of his anxiety.

Here’s Harold’s list of non-threatening situations, in which he practises task concentration techniques:

1 Having dinner with his parents and brother.

2 Socialising with his three closest mates at a local pub.

3 Using public transport during quiet periods.

4 Eating lunch with colleagues at work.

5 Going to the cinema with a friend.

Next is Harold’s list of threatening situations, with each situation becoming gradually more challenging.

1 Walking alone down a busy street.

2 Socialising with strangers at a party.

3 Going to the grocery shop alone.

4 Going to the gym alone.

5 Initiating conversation with strangers.

6 Using public transport during busy periods.

7 Eating alone in a restaurant.

8 Going for an interview.

9 Offering his opinion during work meetings. 10 Giving a presentation for work.

Harold used the principles of task concentration to increase his ability to focus deliberately on chosen external factors in non-threatening situations. When Harold was at the pub with his mates, he focused his attention on what his friends were saying, other people in the pub, the music, and the general surroundings. Harold also deliberately distracted himself by focusing on whether he was blushing and sweating, and then he refocused his attention again.

Harold then used the same techniques in more-threatening situations. In the grocery store, Harold found that the more he focused on his blushing and sweating, the more anxious he felt and the less able he was to pack up his shopping. When he paid attention to the task of packing his groceries, made eye contact with the cashier, and even made a bit of small talk, Harold’s anxiety symptoms reduced, and he became more aware of what he was doing and what was going on around him.

Harold worked diligently through his hierarchy of feared situations and now feels much more confident and relaxed in social situations.

Imagine that you’re going to be called on by the police to act as an eyewitness. For a few minutes, try to take in as much information as you can about the environment and the people around you. Notice how much more detail you can recount when you Choose To focus outwards, compared with when you’re concentrating on your thoughts and physical sensations.

Tackling the task concentration record sheet

You can keep an account of your task-concentration practice, and note the results, by using the task-concentration record sheet in Table 5-1. The brief instructions at the top of the sheet are there to remind you how to do your concentration exercises. You can find a blank copy of the form in Appendix B.

Table 5-1 Harold’s Task-Concentration Record Sheet

Task of eating but it got easier.

Becoming More Mindful

Mindfulness meditation, Commonly associated with Zen Buddhism, has become popular in the past few years as a technique for dealing with depression, and managing stress and chronic pain. Evidence shows that mindfulness meditation can help reduce the chance of problems such as depression returning, and adds another weapon into your armoury against emotional problems.

Being present in the moment

Mindfulness is the art of being present in the moment, without passing judgement about your experience. The mindfulness process is so simple – and yet so challenging. Keep your attention focused on the moment that you’re experiencing Right now. Suspend your judgement about what you’re feeling, thinking, and absorbing through your senses. Simply observe what’s going on around you, in your mind, and in your body without doing anything. Just allow yourself to be aware of what’s happening.

Mindfulness literature talks about the way your mind almost mechanically forms judgements about each of your experiences, labelling them as good, bad, or neutral depending on how you value them. Things that generate good and bad feelings within you get most of your attention, but you may ignore neutral things or deem them to be boring. Mindfulness meditation encourages awareness of the present moment with an uncultured mind, observing even the seemingly mundane without judgement. The whole experience is a bit like looking at the world for the first time.

When you meet someone you know, try to see her through fresh eyes. Suspend your prior knowledge, thoughts, experiences, and opinions about her. You can try this with acquaintances or people you know very well, such as family members and close friends.

Try mindfulness exercises when you’re in the countryside or walking down the street. Whether the surroundings are familiar to you or not, try to see the details of the world around you through fresh eyes.

Letting your thoughts pass by

You can develop your mindfulness skills and use them to help you deal with unpleasant thoughts or physical symptoms. If you have social anxiety for

Example, you can develop the ability to Focus away From your anxious thoughts.

Watching the train pass by

Imagine a train passing through a station. The train represents your thoughts and sensations (your ‘train of thought’). Each carriage may represent one or more specific thoughts or feelings. Visualise yourself watching the train pass by without hopping onto any carriage. Accept your fears about what other people may be thinking about you without trying to suppress them or engaging with them. Simply watch them pass by like a train through a station.

Standing by the side of the road

Another version of the exercise is to imagine that you’re standing on the side of a reasonably busy road. Each passing vehicle represents your thoughts and sensations. Just watch the cars go by. Observe and accept them passing. Don’t try to hitch-hike, redirect the flow of traffic, or influence the cars in any way.

Discerning when not to listen to yourself

One of the real benefits of understanding the way that your emotions influence the way you think, is to know when what you’re thinking isn’t likely to be helpful or very realistic. Being mindful means learning to experience your thoughts without passing judgement as to whether they are true or not.

Given that many of the negative thoughts you experience when you’re emotionally distressed are distorted and unhelpful, you’re much better off letting some thoughts pass you by, recognising them as Symptoms Or Output Of a given emotional state or psychological problem. Chapter 6 covers the Cognitive consequences Of emotions, giving you an idea of the types of thoughts that can occur as a consequence of how you’re feeling.

Becoming more familiar with the thoughts that tend to pop into your head when you feel down, anxious, or guilty makes it easier for you to recognise them as thoughts and let them come and go, rather than treating them as facts. This familiarity gives you another skill to help manage your negative thoughts in addition to challenging or testing them out in reality.

Incorporating mindful daily tasks

Becoming more mindful about little everyday tasks can help you to strengthen your attention muscles. Essentially, everything you do throughout the day can be done with increased awareness. For example, think about the following:

Washing-up mindfully can help you experience the process more fully. Notice the smell of the washing-up liquid, the temperature of the water, and the movement of your hands.

Eating mindfully can give you a more enjoyable eating experience. Slow down the speed you eat, and pay attention to the texture of the food, the subtlety of the flavours, and the appearance of the dish.

Mmmmmmmmmmmm^mmmmmmmmmmm-mmmmmmmmmmmmmmmmmmmmmmmmm

^kay your husband or wife or roommate sees you reading this book for

Hours on end and eventually says something to you like, "Hey, how about giving ME a massage? Right now!"

Your immediate response should be:

A. Sure, lie down on the linoleum here and we’ll get started.

B. No way, I’m too nervous about ever actually doing this stuff.

C. I haven’t finished the book yet.

D. Okay, but give me a few minutes to set the right mood.

Yes, oh intelligent massage student, you’ve once again chosen correctly. The answer is D. It’s definitely true that your partner appreciates it if you take a little time to set up a special environment or "massage mood" before you begin the actual massage. And, even if you’re in a less-than-ideal environment, don’t worry. You can materialize a magical massage mood just about anywhere if you use some of the ideas in this chapter to create your own "inner chamber."

One of the big secrets to giving a good massage has very little to do with the massage itself. It has to do, rather, with where the massage is happening. And I’m not talking about exotic locales like Bali or Atlantic City. I’m referring to more accessible locations, like your bedroom or the couch in your den.

In This Chapter

► Making sure that everything looks, sounds, smells, and feels right

► Trading places

Creating the Inner Chamber

So how do you turn these everyday places into someplace special? It’s easy; the trick is to involve all the senses.

Massage, of course, relies heavily upon the senses for its effects. Your sense of touch, especially, is being bombarded the entire time you’re giving or receiving a massage. But it would be a mistake to neglect the other senses; they can add greatly to your massage experience, too.

The sense of taste doesn’t usually play a big part in massage, unless of course you like to use edible massage oils like strawberry, almond, and mint that are… whoops, I think we’re straying a little beyond the scope of this chapter. Check out Chapter 19 for more information on sensual massage, including the use of all kinds of flavored oils.

Anyway, for now let’s concentrate on the three remaining senses that come into play during a massage experience, also known as the 3 S’s of your inner chamber:

IV Scents V Sights V Sounds

Scents

Professional massage therapists often coach their clients through some deep-breathing techniques as part of the massage. And, as you may suspect, all that breathing includes quite a bit of smelling, too. That’s part of the reason why massage pros have so much concern about the way that their workrooms smell. In addition, they also know how powerful the sense of smell can be for healing and relaxation.

Just sniffing a whiff of corn muffins like the ones your Aunt Betty used to bake when you visited her on weekends as a kid is enough to send you reeling back through the years, right? Why is that so? Aromas trigger a mighty emotional response because the molecules that enter your nose don’t mess around. They do not pass GO; they do not collect $200. Instead, they take a direct route straight into the midbrain area, which is the seat of your emotions and memories. This fact is a key to the power of Aromatherapy.

Aromatherapy

If you use advanced grammatical techniques to break down the word aromatherapy, you discover that it means "therapy with aromas." Aha! So, does that mean therapy with just any aroma, such as the aroma of sauteed onions, for example, or the aroma of diesel fuel at dawn?

Hardly. Aromatherapy is the use of highly concentrated Essential oils From certain plants to stimulate the brain. This stimulation causes a positive effect on the nervous and glandular systems and thus the entire body. During a massage, you can utilize aromatherapy in several ways. In Chapter 11, you find out how to mix up an aromatherapy massage oil, but for now let’s focus on three other aromatherapy tips that can help you scent your massage space.

V Diffusers: As the name suggests, a diffuser diffuses aroma into the air. Several inexpensive models ($10-$ 15) are available that use a miniature fan. Simply place a few drops of your favorite oil on a cotton pad, turn on the fan, and the scent of essential oils fills the room.

V Candles: Many commercially available candles have essential oils worked right into the wax, and burning one during a massage is a great way to combine effects in two of the three S’s, sight and scent. Until recently, you had to visit a specialty shop to purchase aromatherapy candles, but now they’re even available at your local grocery store. S. C. Johnson, for example, makers of Glade air fresheners, is now in the aromatherapy market with candles and sprays.

V Bulb rings: These little doo-dads were popular in the 1970s when they were used to cover up even more exotic aromas floating around the room at parties. Now they’re making a comeback as aromatherapy aids. Basically, they’re floppy little rings that you place over a light bulb. When you sprinkle several drops of essential oil into the ring and turn on the bulb, Presto! — instant aromatherapy.

If aromatherapy is something you’re keenly interested in, I would recommend Aromatherapy For Dummies By Kathi Keville, published by IDG Books Worldwide, a book that promises to answer that age-old question, "How can I smell better and feel better at the same time?"

Incense

The musky, natural scents that burning incense creates can turn your inner chamber into a mystical and exotic environment, even if in reality it’s just your guest bedroom. The problem is, many people overdo it with incense, fumigating the room with enough mystical and exotic smoke to choke themselves, their partner, and any unsuspecting insects living in the walls. This is not good.

When it comes to incense, a little goes a long way. Use it with moderation, and you can create just the right mood. If you’re using one of those long thick sticks of incense, snap it off % of the way down and burn just the last bit. Also, you can crack a window open, weather permitting, to circulate a little fresh air with the smoke.

An altar to the massage gods

Some people go so far as to create a special altar in the area where they give their massages. This is going a bit out into Shirley MacLaine land, I realize, but when you think about it, it makes sense. A massage can be a kind of shared spiritual experience (See Rule # 7 in Chapter 7), and an altar is a way to commemorate that.

So what should be on a massage altar, you ask? You can place the objects mentioned elsewhere in this chapter, such as water fountains, candles, incense burners, and flowers on your altar.

Then you can go a step further and add a photograph or two as well. Pick a subject that reminds you of spiritual things, such as a photo of the Dalai Lama, Saint Francis, or whales cavorting in the waves.

If you spend time meditating or simply sitting quietly at your altar, you can embue the space with a quiet energy. People who join you there may notice the difference. I don’t know if this is due to an actual exchange of peaceful molecules, an increase in negative ions, or what but it can definitely be felt.

There are thousands of brands and "flavors" of incense. My favorite is the Nag Champa scent, which, although I’ve never been there, reminds me of a sacred meditation cave in the Himalayas.

Flowers

Nothing beats the scent of fresh flowers in your massage area. You don’t need a big vase and a big budget to make it happen either. All that’s necessary is a small bowl, a cup, or a mug from the kitchen cabinet that you fill with water, and a single flower. Roses or gardenias work especially well. Snip the flower off the stem and float it on the water. This fills the air with scent for hours or even days.

If you want to get really romantic, spread some fresh petals on the bed or other massage surface to set the mood. Cleopatra had her love chamber filled a foot deep with rose petals before Anthony made his big entrance,__

Sights

It may sound funny to focus on the sights of a massage space because, after all, the person receiving the massage will probably have her eyes closed most of the time anyway. But during those few minutes when she first enters, and whenever she opens her eyes, she’ll soak in her surroundings. There are a few simple things that you can use to add to the relaxing ambience:

IV Candles: Candles cast an enchanting glow over any massage experience, and they can add to the scent as well, as I mention earlier.

V Flowers: Even a small bunch of silk flowers placed with care near the massage area shows this is someplace special.

V Lighting: You can do some simple things with lighting to make your space massage-friendly.

• Turn the lights down low. This helps the person on the receiving end concentrate more on the massage, perhaps because she won’t feel like you are scrutinizing her body under a microscope.

• Throw a silk scarf over a lampshade to create instant mood lighting during a massage.

V Color: Drape the area with soft colorful fabrics.

Sounds

Carefully selected sounds serve two main purposes during a massage:

IV They add to the mood. V They mask other, distracting, sounds like traffic noises and TVs.

There are a number of really interesting ways to make sound a part of your massage, and you may find that some massage pros carry an entire arsenal of sound makers to add to their clients’ experience. Some of my favorites include:

V Tibetan meditation bowls: These look like simple brass bowls, but when you glide a wooden instrument along the rim, they sing out beautifully with rich vibrant tones.

V Ting shahs: Another Tibetan invention, you strike these heavy brass bells together to form a clear, long-lasting tone that sets a meditative mood for a massage.

V Gongs: Yes, miniature versions, complete with a little gong hammer, are available.

V Wind chimes: A classic in the relaxing-sounds category, there are literally thousands of types available. If you can’t be near an open window to hear the chimes, place them indoors near an oscillating fan to simulate blowing breezes.

And, if all else fails… earplugs work wonders. You can get them at your local drugstore.

Water

You know those cute little burbling pots filled with rocks and miniature waterfalls? You can find them in a lot of gift shops these days, and while they are a tad overpriced, they definitely add a lot to the ambience of a massage. If

You’re the industrious type, you can overcome the price problem by building a little indoor fountain for yourself. All it takes is a container, some rocks, and a small submersible water pump.

Of course, being outside near a source of natural flowing water is a great choice, too, but then you have to consider other details, such as temperature, rain, insects, and privacy.

One thing to remember — the sound of running water seems to have a powerful effect on the bladder. Make extra sure your partner visits the bathroom before receiving a massage with a waterfall nearby.

Music, of course, is the most popular type of sound used to complement massage. In most big spas, for example, they pump music directly into the massage rooms from a central sound system, putting the guests in the right mood to relax and unwind.

One massage manufacturing company built stereo speakers right into the bed of a massage table so that when you lie down on it, the music literally vibrates you. While this may be going a bit far, music is still the best and easiest way for you to include the element of sound in your massage.

An entire industry has sprung up to provide music appropriate for massage. If you want to experience some of the most popular massage music, try putting one of the following tapes or CDs on the next time you exchange a massage:

V George Winston’s December

V Pachabel’s Cannon

V Deuter Ecstasy

V Anything by Stephen Halpern

V Brian Eno, Music for Airports

V Ray Lynch, Music to Disappear Into

V Enya, especially her Orinoco Flow CD

V The Cowboy Junkies, Trinity Session (a personal, offbeat favorite)

V Yanni, especially his In My Time

V Any relaxing classical music

Don’t get the wrong idea here, though. Massage music doesn’t necessarily have to be flutes or harps or Yanni ’til you yawn. You can be creative in your choices, and sometimes the best massages are given to the most unlikely accompaniment. See the sidebar "Reggae massage."

Reggae massage

One day when I was in charge of the massage crew at a large spa in Florida, I suddenly was completely fed up with the droning of flutes, harps, and syrupy synthesizer music that poured endlessly out of the stereo speakers in each of the 24 massage rooms. Heading to the sound control room, I secretly exchanged the well-worn New Age CDs for some reggae discs with distinctively upbeat sounds.

It was the middle of a lazy, rainy afternoon. The massage rooms were filled with customers who were all paying upwards of $5,000 per week to be there, and I wasn’t sure exactly what the reaction would be. Would the customers complain? Would I be fired?

After just two hours, the verdict came in, and someone passed me the message… "Steve, the spa director wants to see you in her office."

When I arrived, the director had an expression of profound curiosity on her face. "Do you know what was going on with the music in the massage rooms this afternoon?" she asked.

"I… urn, well…"

"Because whatever it was, the customers loved it. Two of them even wanted to know where they could purchase a copy for themselves! Nobody has ever asked that before."

I was glad to be off the hook, and I was happy to know that most people seemed to agree with me on the subject of massage music. It doesn’t always have to be so… well, tranquilizing.

As a final note about music, remember that the person receiving the massage is always right. This includes being right about the choice of music, even if that choice makes absolutely no sense to you. I had one client who always insisted on receiving his massages to the accompaniment of the local rock & roll radio station. Go figure.

Location location location

Once, in a typically cramped New York City apartment, I had to give a massage on the only available large flat surface, which turned out to be a wooden dining room table. We lay a few blankets and pillows down on it, and I scurried from side to side dodging walls and other furniture, but in the end my client reported feeling quite comfortable, and he loved his massage. I wouldn’t recommend this, but it just goes to show that you definitely don’t need a fancy expensive massage table or a special peaceful room in your house in order to give a good massage.

You can comfortably give massages in any room, including living rooms, bedrooms, family rooms, and as the story above points out, even the dining room. There are a few issues you want to keep in mind, though, when deciding where to give a massage:

Privacy: It’s important to respect the level of privacy the person receiving the massage desires. If possible, choose a room where you can close the doors to keep other people out. On the other hand, some people actually prefer to be less private, and they are more comfortable in an area with some activity.

V Warmth: Avoid areas with a draft or air conditioning vent directly overhead.

V Intentions: It may be a good idea to avoid giving massage in a bedroom if the person receiving is not your romantic partner. That way you avoid possibly giving the wrong message.

V Space: You need some space to maneuver around in ■— perhaps more than you realize. Before you begin, make sure you have enough room on all sides to move without disturbing your partner.

Privacy, ptease

When someone’s receiving a massage, she wants to pretend that she’s on a secluded tropical isle, with no one else around for miles. She’s a Polynesian princess, the center of attention, and the person giving the massage is focused on her and her alone. Exotic birds are floating overhead, and one lone white sail puffs out on the aquamarine horizon… then, suddenly, she hears a voice: "Bart just threw up on my homework!"

Yes, it’s difficult for your partner to achieve her ultimate romantic illusion if, in real life, she’s receiving her massage on the couch in your den, with The Simpsons Turned up full blast on the TV.

Do your partner a favor — indulge her in her illusions. While it’s not always possible to take a trip to Fiji to give your massage, you can avoid some of the more obvious distractions quite easily:

V Turn off the TV.

V Put up a little "Do Not Disturb" sign.

V Try to schedule the massage for a time when there are few interruptions.

V Turn off the ringer on the phone and turn down the volume on the answering machine.

The "massage mood"

What I’ve included in this chapter so far are the external aspects of the inner chamber. But, of course, when it comes to inner chambers, it’s the inside that counts, and that’s what this section is about. Even if you find yourself in a less-than-ideal situation to give massage, with distractions abounding, no music to listen to, and not a candle in sight, you can still create the most important aspect of that inner chamber, the "massage mood."

When you first lay your hands upon someone else to give them a massage, what do you have in your mind? Chances are, you’re a little nervous, a little uncertain of how the other person is going to receive you. And that’s all right. It means you care. But how about how She’s Feeling? You, as the giver, are in charge of creating the optimal mood for her experience.

In order to create an appropriate mood for the other person, what you have to do first is get into that mood yourself. By imagining yourself in one of the following four personas as you begin a massage — saint, doctor, mother, buddy — you can quickly adopt the mood that goes with it. Then, you can give your partner something that comes from deep inside, creating the true inner chamber.

Saint

Part of giving a good massage is having some simple compassion for the person you’re touching. We are, after all, in the same boat, each one of us anchored to a fragile body in an uncertain world. You can reach out to others when you massage them, crossing the barriers of separation, sending the message that you understand how they feel. This is the golden rule of most religions; touch others as you would have them touch you.

Doctor

If you’re just a beginner, you shouldn’t be out there trying to "fix" your Aunt Jeanne’s sciatica with your massage techniques. However, it helps to think in terms of helping the person feel better, not just rubbing oil on. As you begin a massage, imagine your hands filled with healing energy, communicating the intention to soothe and make whole.

Mother

Who ever cared about us more than good ole Mom? She had a level of acceptance for our quirks and our shortcomings that was just plain astounding. You can aim that same kind of unconditional love toward your massage partner (at least for that one hour), making him feel perfect just the way he is.

Touching Jose

(While volunteering at the University of Miami Medical Center AIDS ward, I discovered that you can create a caring compassionate "massage mood" anywhere, even in a sterile hospital room. This is the story of Jose, whom I met there.)

On the bright Christmas Eve morning that we entered his room, Jose’s body was wracked with pain, and he was curled into a fetal position on his hospital bed. His family stood at the foot of the bed arranged like a choir — mother, father, aunts, uncles, siblings, and friends. All of them with their hands at their sides, standing several feet away.

Jackson Memorial Hospital did not employ Rob Boyte, a nurse, and me, a massage therapist. We were volunteers with the RA. LM. S. foundation, and we were there to touch Jose.

You see, nobody else would touch Jose because these were the early days of AIDS and everyone was still afraid, even the doctors and the other nurses. Even the family members of the victims were afraid. Everyone kept his distance.

Jose had received a spinal tap the night before. Convulsions ran through his body, up to his head and back down. He could only speak in broken, grunted syllables. His family translated for us.

"He says he wants the massage," said one relative.

"He thinks it would feel good," said another. "Go ahead, try."

We approached the bed. Both of us stood on the same side, facing Jose’s exposed back. Rob gently placed one large hand on the back of Jose’s neck, not moving it at all. I touched him, too. Jose didn’t relax into the touch; he couldn’t because of the convulsions. He moaned, but not

With pleasure either like many massage clients do. Instead, he moaned with something deeper, almost like pain itself, and I knew immediately what it was. AH of the family members knew what it was, too.

Jose was letting out the primal moan of someone who had not been touched for a long time, at the point in his life when he most desperately needed to be touched.

Subtly, Jose pressed his back up into my hands. I watched the family members lean forward, lifting their hands slightly, as if they too were touching Jose, although they were too terrified to do so themselves.

Slowly, I stroked down Jose’s back, then back up again. His skin was cold, then hot in turns. The family members stared hard at our hands. We were not wearing rubber gloves because we knew AIDS was not transmitted by skin-to-skin contact. Everyone should have known it, but they didn’t.

Slowly, Jose responded. His convulsions subsided. He became quiet. For a few minutes, everyone there could see that he was all wrapped up in the sensation of two other humans, four other hands, touching him, soothing him, being with him in the way that only CONTACT can provide.

Then it was time to go. The ward was filled with other patients on that Christmas Eve day. Rob and I moved to the sink where we washed our hands with red disinfectant soap. We smiled at the family, and they smiled back at the two strangers who had just shared such an intimate moment.

We left the room and moved on. Then, a few minutes later, we heard a gasp, a cry, then a high female wail come echoing down the white

Tiled hospital corridor. The family came flowing out of Jose’s room one by one, their eyes wild with pain, filled with tears. One of the women looked straight into my soul then in that hallway for one brief second. What I saw in her eyes, behind the pain, was gratitude. For a brief time,

I had become her hands and allowed her to do something she would never be able to do herself. Because now, it was too late.

Nobody could touch Jose anymore.

Buddy

Don’t let all this serious stuff about saints and doctors scare you away from giving a massage. There’s another, more lighthearted, giver’s personality, too, that of the buddy. You can just hang out together and have some fun while you’re exchanging massage, and that’s perfectly acceptable. Go ahead, put a little reggae on the CD player. Tell a few jokes to break the ice. Relax and have an easy conversation during the massage. Sometimes this is the best choice when your partner is apprehensive about receiving the massage.

The story in the sidebar "Touching Jose" is an example of how, when it comes time to actually touch a human being, the buddy blends with the saint, and the mother and doctor become two sides of the same coin.

Trading Places

It’s not that difficult to find a professional massage therapist with whom you can trade money for massage. Money seems to be a great motivational tool when it comes to getting people to massage you. It can be very tricky, however, to find an amateur. By definition, you are not going to pay the amateur, and therefore you must offer some other form of incentive to get him to give the massage. Most frequently, this incentive comes in the form of a reciprocal massage. But what if that is not enough to motivate your partner?

I’m trying not to be sexist here, but statistical evidence suggests that one gender in particular has motivational problems when it comes to Giving Massage. Yes, I’m talking about males, 95% of whom, when asked by their loving partners to give a massage, develop an instantaneous and very debilitating case of temporary-fatigue-syndrome (TFS). Even the thought of moving just a pinkie finger suddenly makes them feel very tiried. As soon as the request for massage is withdrawn, however, they bounce back incredibly fast and can often be observed playing touch football just moments later.

Here are some ways to motivate a partner who is the unfortunate victim of TFS:

?, V Suggest to him that his love life might suffer dire consequences unless he gives you a massage.

V Suggest to him that his love life could be greatly enhanced were he to be so kind as to give you a full hour massage.

V In exchange for the massage, offer to let him go shopping at his favorite store (camping store, hardware store, computer store, or whatever his cute little male fixation may be) and don’t bug him about spending money there.

V If he agrees to massage you at least three times, let him pick the destination for your next vacation (yes, even if it’s bass fishing on Lake Okeechobee).

Your mate is not the only person with whom you can form a massage-trade relationship. Other potential partners include:

‘ V Somebody who practices massage professionally (it may surprise you how many pros don’t receive massage nearly as often as they’d like — your offer to trade, although you’re less experienced, is likely to be met with considerable enthusiasm).

V Members of your church

V Members of your family

V Friends of the family

; V Members of a sports team you’re on

It may be challenging at first to find a way to be comfortable trading massages. It’s an admittedly intimate form of sharing, and not everyone takes to it right away. One good alternative to jumping straight into a full body massage is to try some seated massage with the clothes still on. You may find plenty of non-threatening options in the chapters to come.

Chapter 10