■ n Chapter 16, I mention the possibility of buying prescription drugs from

Abroad by mail order as a way to lower expenses in Part D’s doughnut hole (formally called the coverage gap). You need to weigh the pros and cons, but if you decide to go this route, your chief concern is to make sure you order from a legitimate, licensed pharmacy that sends you the drugs your doctor prescribed.

Importing prescription drugs from abroad is still illegal in the United States. (Congress has passed legislation to legalize the practice, but it has never been put into effect, for reasons explained in Chapter 21.) However, no American has ever been prosecuted for importing drugs for his own personal use, and it’s extremely unlikely that anybody would be. For the millions of otherwise law-abiding citizens who’ve ordered prescription drugs from abroad — mostly senior citizens before Medicare drug coverage began in 2006 — it’s a no-brainer. The same meds that cost a fortune without insurance in the U. S. can often be bought from Canada and other countries, where drug prices are nationally regulated, for much less.

Certainly, getting drugs from abroad can be risky — unless you’re careful. Unscrupulous sellers who lurk behind anonymous Web sites peddle counterfeit and other harmful drugs. Scammers will take your money without sending you any meds. The U. S. Food and Drug Administration regularly cites these reasons in warning Americans against buying drugs from abroad.

But many reputable online pharmacies sell bona fide prescription drugs to Americans safely and ethically. This appendix shows you how to find those that offer quality services and how to avoid the ones that are dubious. It also suggests ways of locating pharmacies that have been prescreened for safety and service by state governments or organizations that give seals of approval to online pharmacies that meet certain standards.

In these pages, I focus on ordering drugs from licensed Canadian pharmacies. The Canadian federal and provincial governments regulate pharmacy practices and drug safety as rigorously as American health authorities do, and after nearly a decade of experience in the cross-border trade, these pharmacies have an established track record. They operate mail-order services because that’s the only way most Americans can buy drugs from Canada, although many people living in the northern-most states physically cross the border to fill prescriptions in regular drugstores. The mail-order pharmacies maintain Web sites that state their drug prices and policies and allow you to order online.

What if you don’t have Internet access? You can order meds by phone from a mail-order pharmacy, but first you’ll usually need someone to go online to look for a reputable one (by using the suggestions in this chapter) and find its phone number. Or you can call one of the state-operated services that provide links to prescreened Canadian pharmacies, as described later in this chapter.

Distinguishing the Good Guys from the Bad

Just because an online pharmacy Says It’s based in Canada doesn’t mean it is. And just because it has a Canadian address doesn’t mean it necessarily provides good service. Here are ways to evaluate legitimate pharmacies and avoid dubious sellers so you can be more confident that the medications you’ll receive are the ones your doctor prescribed.

Assessing safe and ethical service

American and Canadian pharmacy experts recommend that you choose an online pharmacy that uses the following best practices of

U Displaying on its Web site its license number and the name of the Canadian regulatory agency that granted it. This means you can check that it’s an authentic pharmacy. As an American, you have the same right to complain about a pharmacy to its licensing agency as a Canadian does.

U Displaying on its Web site the approval seals of organizations that set standards for safety and service and accredit pharmacies that meet the standards. See the next section for details of these organizations and how to ensure that the seals posted on pharmacy Web sites are genuine.

U Requiring a prescription from your doctor. This isn’t a hassle — it’s your best safety protection. Some reputable pharmacies may allow you to fax in the prescription, but will then phone your doctor to confirm the prescription or wait until they receive the original one in the mail before filling your order.

U Requiring you to have taken the drug for at least one month before you order by mail so you and your doctor know it’s working well for you.

U Requiring you to submit details of your medical history, usually through an online questionnaire.

U Stating its policy for ensuring your medical and personal privacy in clear language on its Web site.

U Sending drugs in the manufacturer’s original container with seals intact. This is normal practice among reputable Canadian pharmacies. In some cases, though, they may send drugs in regular pharmacy bottles if the manufacturer’s own containers hold different quantities than you order.

U Sending drugs with labeling written in English that includes strength, dosing directions, expiration date, appropriate warnings, and a Drug Identification Number (DIN) that shows the drug has been approved by the Canadian government health authorities.

U Explaining differences between American and Canadian drug names and labeling. The same drugs sometimes have different names in other countries.

U Explaining why it can’t provide certain drugs. Reputable pharmacies don’t sell drugs that are regarded as controlled substances under American law (like narcotics), or drugs that can’t be sent safely through the mail (such as some that require careful handling or refrigeration).

U Providing a full mailing address and a toll-free phone number on its Web site so you can call the pharmacist with questions, check on the status of an order, or order by phone instead of online if you prefer.

U Displaying on its Web site full information about shipping fees, payment policies, and refunds. Reputable pharmacies offer encrypted (that is, secure) online payment for credit cards, alternative payment options (such as electronic fund transfers and regular checks), and don’t charge any separate fees except for shipping.

U Charging the cost of drugs to your credit card only when they’ve been shipped to you — and not when the order is first placed.

U Refunding your money or shipping replacement drugs immediately if your order doesn’t arrive. Reputable pharmacies will do this even if your shipment is intercepted and confiscated by U. S. Customs, a practice that has happened in the past but has become much rarer in recent years since Congress condemned it.

Avoiding scams and dubious sellers

The snake oil salesmen are still out there and thriving — though these days they’re usually peddling fake Viagra and other drugs that folks feel too shy to ask their doctors about. These are basic guidelines for avoiding unscrupulous sellers and counterfeit drugs:

W Never use an online pharmacy that offers to sell you a prescription drug without a doctor’s prescription. This is the number-one no-no — a clear sign of unethical and potentially dangerous practices.

W Never use an online pharmacy that sends you an uninvited e-mail.

Those unwanted e-mails that pop up so frequently in your in-box should always be seen as outright attempts to scam you. Delete them!

W Don’t trust an online pharmacy that doesn’t display a customer service number on its Web site. If there’s no phone number, you can’t contact the pharmacy — so how can you know it actually exists?

Finding a Pharmacy You Can Trust

The best way to find reputable licensed pharmacies that give quality service is to use some kind of filter — that is, a system that has already identified pharmacies that operate according to the best practices listed in the "Assessing safe and ethical service" section. In the following sections, I suggest two types of filters:

W Programs set up by state governments to link consumers to prescreened Canadian pharmacies

W Organizations that give seals of approval to online pharmacies that meet their standards

Using state links to Canadian pharmacies

In 2003-04, two state governors lost patience waiting for the federal government to legally allow people access to low-cost prescription drugs from Canada. Both governors created Web sites offering links to Canadian pharmacies that state health officials have prescreened and regularly inspect to ensure safety and quality service.

W Minnesota RxConnect: This program, set up by Minnesota Governor Tim Pawlenty in 2003, offers links to four prescreened Canadian pharmacies. Some other states (and the District of Columbia) direct their residents to this program, but residents of any state can use it. Go to rxconnect. dhs. state. mn. us and click "Order Your Medicine from Canada." Or call 800-333-2433.

W Illinois I-SaveRx: This program, created by Illinois Governor Rod

Blagojevich in 2004, offers a link to one prescreened Canadian pharmacy. The program is open to residents of Illinois, Kansas, Missouri, Vermont, and Wisconsin. Call 866-472-8333 or go online to Www. i-saverx. net.

Looking online for seals of approval

Iijj|kB£W Hundreds of advertisements for low-cost prescription drugs litter the Internet, aimed at Americans who are trying to save money on their prescriptions. Every time you go online to search for any medical topic, these ads pop up onscreen in profusion. Some are legitimate, and some are total rip-offs. How can you tell which are which? You can’t. However, you can play it safe. Ignore the ads. Instead, look for licensed pharmacies that display, on their Web sites, the seals of approval awarded by organizations that have screened them to meet certain safety and service standards.

Here’s where those seals of approval come from:

W Internet and Mail-Order Pharmacy Accreditation Commission (IMPAC):

IMPAC was founded in 2003 in Vermont by an independent group of doctors and pharmacists to promote consumer safety and quality service among licensed mail-order pharmacies in the U. S. and other countries. A pharmacy must meet rigorous standards during a two-day on-site inspection every two years to receive and retain IMPAC accreditation. To see a list of the currently accredited pharmacies, go to Www. impac Survey. org or call 800-677-7019.

W Canadian International Pharmacy Association (CIPA): CIPA was formed in 2002 to represent licensed Canadian pharmacies that sell prescription drugs to Americans by mail order and that meet its safety, service, and ethical standards. The group has testified before Congress and state legislatures to address safety issues and to promote U. S. legalization of the cross-border trade for consumers buying prescription drugs from Canada for their personal use. To verify that a pharmacy is currently accredited by CIPA, go to Www. ciparx. ca.

W Better Business Bureau (BBB): The BBB awards its BBBOnline seal of approval to Web sites that meet its standards for ethical service, trustworthy business practices, and truth in advertising. You can check out BBB records for an online pharmacy, including whether the BBB has received consumer complaints about it, at Www. bbbonline. org. If you go to a pharmacy Web site that displays the BBB seal, clicking the seal will take you straight to the BBB report on that pharmacy.

W PharmacyChecker. com: This Web site, run by an independent American consumer research group, provides ratings and drug price comparisons for about 30 online pharmacies in the US. and abroad (mainly Canada). It gives its "verification" seal to those that meet five service standards — it’s licensed, requires a doctor’s prescription, displays its address and phone number, offers secure online financial transactions, and promises privacy for medical information. The site also posts names of "rogue" pharmacies that it considers unethical or unsafe. It compares prices for more than 1,000 drugs at verified pharmacies and posts customers’ comments on quality of service. Check it out at Www. pharmacychecker. com.

JttNG/ Approval seals awarded by these organizations provide a useful guide for

Consumers looking for a legitimate online pharmacy. However — wouldn’t you know? — some scam artists use these seals too to cheat customers by posting copies of them on their own rogue Web sites. The copies are good — you wouldn’t know the difference just by looking at them. However, you can verify whether the displayed seals are genuine or fraudulent. Clicking the image of a seal on a pharmacy Web site should take you straight to the Web site of the organization that awarded it, whether IMPAC, CIPA, BBB, or PharmacyChecker. If nothing happens, you can be sure that the seal isn’t genuine. Or you can go directly to the organization’s Web site and enter the name of the pharmacy. This will tell you whether the pharmacy is entitled to display the seal.

■ J Ery often, the help you need to deal with Part D plan issues is only a tollEr Free phone number or a Web site away. In these pages, I give contact information for government help lines and online resources; independent organizations that offer direct help; where to go for updated info on Medicare and Part D and for ways to save money; and advocacy organizations that work on behalf of people in Medicare. Throughout, I note special help provided for people whose first language isn’t English.

Government Help Lines and Web Sites

The go-to sources for help provided by federal and state governments are the Centers for Medicare & Medicaid Services (CMS), the Social Security Administration (SSA), the State Health Insurance Assistance Programs (SHIPs), and the Eldercare Locator.

The Centers for Medicare & Medicaid Services

CMS is the federal agency that runs Medicare and Medicaid (under the umbrella of the U. S. Department of Health and Human Services) and is responsible for overseeing the Part D drug coverage program. It provides updated information and direct help to consumers in English and Spanish.

The Medicare & You Handbook is sent to everyone on Medicare every October. This basic overview of Medicare services also includes brief details of the Medicare private health plans and Part D stand-alone drug plans that will be available in your area for the following year.

Medicare’s toll-free help line at 800-633-4227 is available 24 hours a day, 7 days a week. (TDD users should call 877-486-2048.) The folks on the other end of the line can answer your questions, send you free fact sheets, and give you help on many Medicare and Part D issues. If neither English nor Spanish is your first language, you can ask for an interpreter — more than 70 languages are available.

W Medicare’s Web site, Www. medicare. gov, offers a huge amount of information. Go to this site to compare Part D plans, Medicare private health plans, nursing homes, and hospitals.

The Social Security Administration

SSA is the federal agency that administers Social Security benefits. Call SSA toll-free at 800-772-1213 (TDD: 800-325-0778) or go to its Web site at www. Ssa. gov for information on Social Security, enrolling in Medicare Part A and/or B, and applying for Part D’s Extra Help program.

The SSA Web site can be read in Arabic, Armenian, Chinese, Farsi, French, Greek, Haitian-Creole, Italian, Korean, Polish, Portuguese, Spanish, Russian, Tagalog, and Vietnamese, as well as English. To choose a language, click the "Other Languages" button at the top of the home page. You can also ask for an interpreter in any language when you call the help line (press 2 for Spanish or 1 for any other language) or when you arrange to visit a local Social Security office.

State Health Insurance Assistance Programs

SHIPs are valuable resources for anyone who needs help with Medicare issues, especially Part D. They offer free, expert, personal counseling when you want to find a Part D plan that fits your needs, apply for Extra Help, get help making an appeal, or resolve a variety of other problems. If English isn’t your first language, the program can provide interpreters or refer you to local organizations that offer counseling in your own language.

SHIPs, which are funded by the federal and state governments, are available in every state, the District of Columbia, Guam, Puerto Rico, and the U. S. Virgin Islands. The programs have different names in some states (for example, HICAP in California; SHINE in Florida). The following list includes every program, its name, the state agency that runs it, a toll-free telephone number (except for D. C. and the territories, which have local numbers), and the Web address. If the number you call isn’t working, call the Eldercare Locator at 800-677-1116 or go to Www. shiptalk. org or Www. hapnetwork. org/ ship-locator for an updated number. (Find out more about the Eldercare Locator in the next section.)

Alabama

SHIP, Department of Senior Services Montgomery, AL

Phone 800-243-5463

Web site Www. ageline. net/ ship. cfm

Alaska

SHIP, Department of Health and Senior Services Anchorage, AK

Phone 800-478-6065

Web site Www. hss. state. ak. us/ dsds/shipMedicare. htm

Arizona

SHIP, Aging and Adult Administration Phoenix, AZ

Phone 800-432-4040

Web site Www. azdes. gov/aaa/ Arkansas

SHIIP, State Insurance Department

Little Rock, AR Phone 800-224-6330

Web site Www. insurance. Arkansas. gov/seniors/ homepage. htm

California

HICAP, Department of Aging Sacramento, CA

Phone 800-434-0222 (TDD

800-735-2929)

Web site Www. cahealthadvocates. org/HICAP/index. html

Colorado

SHIP, Division of Insurance Denver, CO

Phone 888-696-7213 (TDD

303-894-7880)

Web site Www. dora. state. co. us/ insurance/senior/senior. htm

Connecticut

CHOICES, Department of Social

Services

Hartford, CT Phone 800-994-9422

Web site Www. ct. gov/aging services/site/default. asp

Delaware

ELDERinfo, Insurance Department Dover, DE

Phone 800-336-9500

Web site delawareinsurance. gov

District of Columbia

Health Insurance Counseling Project, George Washington University Washington, D. C.

Phone 202-739-0668

Web site Www. law. gwu. edu/

Academics/Clinical+Programs/

Health+Rights+Law+Clinic. htm

Florida

SHINE, Department of Elder Affairs Tallahassee, FL

Phone 800-963-5337 (TDD 800-955-8771)

Web site Www. floridashine. org Georgia

GeorgiaCares, Division of Aging Services

Atlanta, GA

Phone 800-669-8387 (TDD 404-657-1929)

Web site aging. dhr. georgia. gov/portal/site/DHR-DAS

Guam

Division of Senior Citizens, Department of Public Health and Social Services Hagatna, Guam

Phone 671-735-7388 or 671-735-7393 (TDD 671-734-7415)

Hawaii

SAGE Plus, Executive Office on Aging

Honolulu, HI

Phone 888-875-9229 (TDD

866-810-4379)

Web site Www4.hawaii. gov/eoa/ programs/sage_plus

Idaho

SHIBA, Department of Insurance

Boise, ID

Phone 800-247-4422

Web site Www. doi. state. id. us/ shiba/shibahealth. aspx

Illinois

SHIP, Department of Insurance Springfield, IL

Phone 800-548-9034 (TDD (217-524-4872)

Web site Www. idfpr. com/DOI/ Ship/ship_help. asp

Indiana

SHIIP, Department of Insurance Indianapolis, IN

Phone 800-452-4800

Web site Www. in. gov/idoi/ 2399.htm

Iowa

SHIIP, Insurance Division

Des Moines, IA

Phone 800-351-4664 (TDD

800-735-2942)

Web site Www. shiip. state. ia. us

Kansas

SHICK, Kansas Department on Aging Topeka, KS

Phone 800-860-5260

Web site Www. agingkansas. org Kentucky

SHIP, Division of Aging Services

Frankfort, KY

Phone 877-293-7447 (TDD

888-642-1137)

Web site Chfs. ky. gov/agencies/ os/dail/ship. htm

Louisiana

SHIIP, Department of Insurance Baton Rouge, LA

Phone 800-259-5301

Web site Www. ldi. state. la. us/ Health/SHIIP/index. htm

Maine

HICAP, Bureau of Elder and Adult

Services Augusta, ME

Phone 800-262-2232 (TDD

800-606-0215)

Web site Www. state. me. us/dhs/ beas/hiap/purpose. htm

Maryland

SHIP, Department of Aging Baltimore, MD Phone 800-243-3425 (TDD

800-637-4113)

Web site Www. mdoa. state. md. us/ ship. html

Massachusetts

SHINE, Executive Office of Elder Affairs Boston, MA

Phone 800-243-4636 (TDD 800-872-0166)

Web site Www. mass. gov/elders

Michigan

MMAP, Medicare/Medicaid Assistance Project Lansing, MI

Phone 800-803-7174

Web site Www. mymmap. org

Minnesota

SHIP, Minnesota Board on Aging

St. Paul, MN Phone 800-333-2433

Web site Www. mnaging. org/ advisor/SLL. htm

Mississippi

MICAP, Division of Aging and Adult Services Jackson, MS

Phone 800-948-3090

Web site Www. mdhs. state. ms. us/ aas_info. html#MICAP

Missouri

CLAIM, Patient Care Review Foundation Columbia, MO Phone 800-390-3330

Web site Www. missouriclaim. org

Montana

SHIP, State Office on Aging Helena, MT

Phone 800-551-3191 (TDD

406-444-2590)

Web site Www. dphhs. mt. gov/

Sltc/services/aging/ship.

Shtml

Nebraska

SHIIP, Department of Insurance Lincoln, NE

Phone 800-234-7119 (TDD

800-833-7352)

Web site Www. doi. ne. gov/shiip Nevada

SHIP, Division of Aging Services Las Vegas, NV

Phone 800-307-4444

Web site Www. nvaging. net/ship/ ship_main. htm

New Hampshire

NH ServiceLink Resource Center Laconia, NH

Phone 866-634-9412 (TDD

800-735-2964)

Web site Www. nh. gov/service

Link

New Jersey

SHIP, Division of Senior Aging and Community Services Trenton, NJ

Phone 800-792-8820

Web site Www. state. nj. us/ health/senior/ship. shtml

New Mexico

Health Insurance Benefits Assistance Corps

Santa Fe, NM Phone 800-432-2080

Web site Www. nmaging. state. nm. us/benes. html

New York

HIICAP, State Office for the Aging Albany, NY

Phone 800-701-0501 Web site Www. hiicap. state. ny. us

North Carolina

SHIIP, Department of Insurance

Raleigh, NC

Phone 800-443-9354 (TDD 800-735-2962)

Web site Www. ncshiip. com

North Dakota

SHIC, Insurance Department Bismarck, ND

Phone 888-575-6611 (TDD 800-366-6888)

Web site Www. nd. gov/ndins Ohio

OSHIIP, Department of Insurance Columbus, OH Phone 800-686-1578 (TDD

614-644-3745)

Web site Www. ohioinsurance. gov

Oklahoma

SHICP, Insurance Department

Oklahoma City, OK Phone 800-763-2828

Web site Www. oid. state. ok. us/ www2.oid. state. ok. us/ divisions/shicp. asp

Oregon

SHIBA, Division of Insurance

Salem, OR

Phone 800-722-4134 (TDD 800-735-2900)

Web site Www. oregon. gov/DCBS/ SHIBA/index. shtm

Pennsylvania

APPRISE, Department of Aging Harrisburg, PA

Phone 800-783-7067

Web site Www. aging. state. pa. us/aging/cwp/view. asp? a=553&q=253 802

Puerto Rico

Governor’s Office of Elderly Affairs San Juan, PR

Phone 787-725-4300

Rhode Island

SHIP, Department of Elderly Affairs Cranston, RI

Phone 401-462-4000 (TDD 401-462-0740)

Web site adrc. ohhs. ri. gov

South Carolina

I-CARE, Office on Aging Columbia, SC

Phone 800-868-9095

Web site Www. aging. sc. gov/ Seniors/ICARE. htm

South Dakota

SHIINE, Center for Active Generations Sioux Falls, SD

Phone 800-536-8197

Web site Www. shiine. net

Tennessee

SHIP, Commission on Aging & Disability

Nashville, TN

Phone 877-801-0044 (TDD

615-532-3893)

Web site Www. state. tn. us/ comaging/ship. html

Texas

HICAP, Department of Aging Austin, TX

Phone 800-252-9240 (TDD 800-735-2989)

Web site Www. dads. state. tx. us/ services/dads_help/aaa/ hicap. html

Utah

SHIIP, Division of Aging and Adult Services

Salt Lake City, UT

Phone 800-541-7735 Web site Www. hsdaas. utah. gov/ insurance_programs. htm

Vermont

Area Agency on Aging St. Johnsbury, VT

Phone 800-642-5119

Web site Www. medicarehelpvt. net

Virgin Islands

VI SHIP

Christiansted, VI

Phone 340-772-7368 (St. Croix);

340-714-4345 (St. Thomas/St. John) Web site ltg. gov. vi/vi-ship-medicare. html

Virginia

VICAP, Department for the Aging Richmond, VA

Phone 800-552-3402 (TDD 800-552-3402)

Web site Www. vda. virginia. gov/ vicap2.asp

Washington

SHIBA, Office of the Insurance Commissioner Olympia, WA

Phone 800-562-6900 (TDD 360-586-0241)

Web site Www. insurance. wa. gov/ shiba/index. shtml

West Virginia

SHINE, Bureau of Senior Services

Charleston, WV Phone 877-987-4463

Web site Www. wvseniorservices. gov

Wisconsin

SHIP, Bureau of Aging and Long Term Resources Madison, WI

Phone 800-242-1060 (TDD

866-796-9725)

Web site Www. dhfs. state. wi. us/ aging/SHIP. htm

Wyoming

SHIIP, Wyoming Senior Citizens Inc. Riverton, WY

Phone 800-856-4398

Web site Www. wyomingseniors.

Com/WSHIIP. htm

The Eldercare Locator

The Eldercare Locator is a free public service run by the U. S. Administration on Aging. It acts as a national clearinghouse for Americans age 60 and over to find help and resources in their own communities. It can connect you to local agencies and organizations that provide many different kinds of services and assistance programs, typically those that help people continue to function at home or in their communities as they age.

V Phone: 800-677-1116 (toll-free), Monday through Friday, 9 a. m. to 8 p. m. Eastern Time. The Language Line can handle 150 languages.

V Web: Www. eldercare. gov. (For a list of links to home – and community-based services, go to Www. n4a. org/locator/el_hcbs. cfm.)

Independent Sources of Direct Help

The following agencies are nonprofit organizations that are very similar to the SHIPs I list earlier. They offer free direct help to consumers on Part D issues, but are national and sometimes provide more specialized services. They also act as advocates on behalf of Medicare beneficiaries in Congress and state legislatures.

The Medicare Rights Center

The Medicare Rights Center (MRC) is an independent, New York-based organization that offers information and free legal help and representation on Medicare issues to consumers throughout the country. It also acts as a consumer watchdog and advocate for improving Medicare benefits (including Part D).

V Consumer hot line: Call 800-333-4114 (toll-free), Monday through Friday between 9 a. m. and 6 p. m. Eastern Time, to talk to a counselor about health insurance options, Medicare rights and protections, billing problems and payment denials, and complaints and appeals.

V Medicare appeals hot line: Call 888-466-9050 (toll-free) Monday through Thursday, noon to 2 p. m. Eastern Time to leave a message. This service provides free help with appeals if your Medicare health plan or Part D plan has denied you care or coverage that you need.

V LINCS hot line: Call this program Only If you’re a low-income New Yorker. LINCS (Linking Individuals in Need to Care and Services) can help you apply for Extra Help in Part D and/or connect you to other programs in New York that may reduce your prescription drug costs. Call 888-795-4627

(toll-free).

V Online information: For consumer guides on Medicare and the option of receiving free newsletters by e-mail or joining online seminars on Medicare topics, go to Www. medicarerights. org.

The National Alliance for Hispanic Health

The National Alliance for Hispanic Health (NAHH) promotes the health and well-being of Hispanics through community programs that reach more than 14 million Hispanics throughout the country. It provides written information and free counseling services in English and Spanish on health programs for consumers of all ages, including direct help on Part D drug coverage. Based in Washington, D. C., NAHH is also a leader in advocacy and research for Hispanic health.

V Phone: You can call the National Hispanic Family Health Helpline (Su Familia) at 866-783-2645 toll-free Monday through Friday, 9 a. m. to

6 p. m. Eastern Time, for free one-on-one counseling on any health issue. A popular part of this service is personal help with Part D, including finding a drug plan and applying for Extra Help.

V Web: The NAHH Web site at Www. hispanichealth. org has a wealth of health information and publications in English and Spanish. For Medicare information, click "Community" and then "Medicare."

The National Asian Pacific Center on Aging

The National Asian Pacific Center on Aging (NAPCA) promotes the health and well-being of senior Asians and Pacific Islanders throughout the U. S. through advocacy, education, and direct help. It provides details on a range of aging issues and free counseling to help navigate Part D drug coverage.

V Phone: The NAPCA National Toll-free Multilingual Helpline Center specifically deals with Part D issues, offering personal bilingual counseling on any aspect of the program — choosing a plan, helping with enrollment, applying for Extra Help, and troubleshooting problems. Call 800-582-4218 (Chinese); 800-582-4259 (Korean); 800-582-4336 (Vietnamese); or 800336-2722 (English).

V Web: The NAPCA Web site at Www. napca. org has information for Asian Americans and Pacific Islanders on healthcare and long-term care, employment, education, welfare reform, and many other issues.

Resources for Saving Money

The following resources can help you save money on prescription drugs through various public and private programs for people with limited incomes:

V BenefitsCheckUp (Www. benefitscheckup. org): This Web site, a service of the National Council on Aging, allows you to find national, regional, state, or local programs that provide benefits you may qualify for without realizing it — or perhaps never knew existed. It has helped more than 2 million users find more than $6 billion In benefits. Online, you’re asked about your zip code, age, health status, family circumstances, and income. You do Not Give your name, address, or any other identifying information. You can search for benefits that will help pay for prescriptions and/or other benefits to reduce your living expenses. You can also search the Senior Housing Locator to find housing options, including assisted living, residential and nursing home care, and independent-living retirement communities.

V The Health Resources and Services Administration: This federal agency, a division of the U. S. Department of Health and Social Services, provides a Web site, ask. hrsa. gov/pc, that allows you to locate clinics in your area for free or low-cost healthcare and medications.

V The National Council on Aging: This nonprofit organization sponsors many programs designed to help older Americans stay healthy and independent, find jobs and community service opportunities, and link them to benefits and resources. It provides consumer information and invites questions through its Web site at Www. ncoa. org. If you don’t have Internet access, you can call its Washington headquarters or four regional offices to ask for the phone numbers of resources in your community: Washington, D. C., 202-479-1200 (TDD 202-479-6674); San Francisco, California, 415-982-7007; Lakewood, New Jersey, 732-367-7111; Steubenville, Ohio, 740-283-2182; Nashville, Tennessee, 615-834-4900.

V The Partnership for Prescription Assistance: This organization gives a single access point for getting information on more than 475 public and private assistance programs — including 180 offered by pharmaceutical manufacturers — that provide free or low-cost prescription drugs to people with limited incomes. To see whether you qualify for any programs, go to the Web site at Www. pparx. org or call toll-free 888-477-2669. You’ll be asked to list your prescription drugs and give some information about yourself, including approximate income and savings — but not your name or any other identifying information. Any program you qualify for is identified, with instructions on how to apply. In many cases, you can download application forms from the Web site, fill them out, and take them to your doctor to send in. This Web site can be read in Spanish by clicking the "Espanol" button at the top of the home page.

Consumer Information and Advocacy Organizations

The nonprofit organizations listed in this section are leading sources of information on Medicare and act as advocates on behalf of Medicare beneficiaries within Congress and state legislatures. They want to hear about people’s first-hand experiences with Medicare (including Part D), and they welcome volunteers to help their efforts.

V AARP Uses the power of its membership (nearly 40 million members in 2008) to promote the interests of people age 50 and over. These interests include improving Medicare and Part D, preserving Social Security, and promoting legislation to achieve health insurance access for all Americans. A nonpartisan organization with headquarters in Washington, D. C., AARP has offices in every state (plus the District

Of Columbia, Puerto Rico, and the U. S. Virgin Islands) and advocates in Congress and all state legislatures. Through the AARP Foundation, attorneys litigate court cases of special importance to older Americans. Among other publications, its news magazine Segunda Juventud Is for Spanish-speaking members. Toll-free phone 888-687-2277 (TDD 877-434-7598), Monday through Friday, 7 a. m. to midnight Eastern Time; Web site Www. aarp. org.

V The Center for Medicare Advocacy Promotes the interests of people on Medicare nationally and is staffed by policy experts, attorneys, researchers, and information specialists. Based in Connecticut, with an office in Washington, D. C., the nonpartisan center advocates to improve

Medicare services and other healthcare rights, litigates court cases, and publishes policy documents and consumer information. It invites consumers to send in questions to its Web site and responds to about 7,000 telephone and e-mail inquiries each year. Phone 860-456-7790

(Connecticut) or 202-293-5760 (Washington); Web site (with e-mail link)

Www. medicareadvocacy. org. This site can be read in Spanish by clicking the "Espanol" button at the top of the home page.

V California Healthcare Advocates Is the leading consumer watchdog organization for Californians on Medicare. Based in Sacramento, with offices in Los Angeles, Oakland, and Santa Ana, CHA conducts public policy research and community outreach; promotes recommendations for improving Medicare services and rights at the federal and state level; and provides up-to-date consumer information on its Web site, including the publication California Medicare News. Phone 916-231-5110 (Sacramento); Web site Www. cahealthadvocates. org.

V Families USA Is a grassroots, nonpartisan organization that promotes quality healthcare for all Americans from the consumer perspective. Based in Washington, D. C., it serves as a consumer watchdog on government actions related to health coverage, including Medicare and Part D. It also provides updates on developments in the pharmaceutical industry and regularly publishes surveys of drug prices. Phone 202-628-3030; Web site Www. familiesusa. org.

Sources for Updates on Medicare and Part D

Although the bulk of information in this book is likely to remain current, new regulations and some new Medicare services are introduced from time to time. Also, payment requirements (for example, Part B premiums), Part D coverage levels, and Extra Help out-of-pocket expenses change annually. You can find ongoing updates from these sources:

V Medicare Interactive Counselor: This free, searchable, comprehensive consumer guide, developed and regularly updated by the Medicare Rights Center (which I introduce earlier in this appendix) provides hundreds of answers to questions about Medicare. Go online to www. Medicareinteractive. org or to Www. medicareinteractive. org/aarp.

V Ask Ms. Medicare: You can e-mail questions about Medicare to me (the author of this book) through the AARP Bulletin’s Web site, bulletin. aarp. org. Click the "Ask Ms. Medicare" link on the home page to view past questions and answers and (if you can’t find what you’re looking for) submit a new question.

V AARP Medicare information: You can find news, consumer guides, articles, and discussion boards about Medicare and other forms of health insurance (such as Medigap and COBRA) online at Www. aarp. org/

Health/insurance.

Appendix C

In This Appendix

^ Making a list of prescription drugs

^ Comparing Part D plans to make your final cut

^ Seeing how Medicare Advantage health plans measure up to one another

•bInding the best drug plan among scores of possibilities — when each W One has its own costs and benefits and is different from the next — can be a nightmarish prospect. But it doesn’t have to be a nightmare in practice. In Part III, I explain how you can whittle those choices down to a manageable few — by first deciding whether you want to receive your healthcare from traditional Medicare or from a Medicare Advantage plan and then by comparing Part D plans head-to-head according to what they charge for the drugs you take (and other factors that may be important to you).

Using checklists and notes of point-by-point comparisons to track the info you’re compiling can help you more clearly see the differences between the plans you’re considering so you can make that final cut — down to one. This appendix has three worksheets designed to help you do just that.

Worksheet 1 Is essentially your master list. It provides an organized way of jotting down complete information on all the prescription drugs you take. This is the list you need to make before you can compare Part D plans properly, as explained in Chapter 10.

Worksheet 2 Is the tool to use after you’ve searched the online Medicare Prescription Drug Plan Finder (or had someone do this for you), as explained in Chapter 10, and reduced your number of drug-plan options to a shortlist of three or four that seem best. You can use this worksheet to finalize your choice among either stand-alone prescription drug plans (PDPs) or Medicare Advantage health plans that cover drugs (MAPDs).

Worksheet 3 Is a checklist to use when considering Medicare Advantage plans for their health costs and benefits, as explained in Chapter 9, after you’ve reduced these plans to a shortlist of the three or four that seem best for you.

Worksheet 1 is the essential list you must make before comparing Part D plans, as explained in Chapter 10. For each of the drugs you take, write down its exact name together with any other words or letters that follow the name (for example, verapamil HCR ER), its dosage (120 mg, 2.50 ml, and so on), and how often you take it (one pill a day, one bottle a month, and so on).

Worksheet 1 Your Personal List of Prescription Drugs

Full Name of Prescription Dosage How Often You

Drug Take Drug

1_

2_

3_

4_

5_

6_

7_

8_

9_

H)_

11 12 13 14 15 16 17

Worksheet 2 is designed to be used with the online Medicare Prescription Drug Plan Finder, found at Www. medicare. gov. The plan finder tool provides answers to the following questions, as I describe in Chapter 10.

What will be my total estimated out-of-pocket costs over the year at Retail pharmacies Under this plan? (Dollar amount)

What will be my total estimated out-of-pocket costs over the year under this plan’s Mail-order service? (Dollar amount or N/A if mail order not offered)

What will my total estimated out-of-pocket costs be over the year under this plan if I choose available Lower-cost drugs? (Dollar amount)

How many of my drugs come with any restrictions: prior authorization, quantity limits, step therapy? (for example, 1 PA, 2 QL, 0 ST)_

Will I fall into the coverage gap under this plan? (Yes or no)

Does this plan cover any of my drugs in the gap? (Yes or no)

Does this plan use pharmacies that are convenient for me? (Yes or no)

What are this plan’s ratings for customer service? (POor, FAir, GOod, VEry GOod,

EXcellent)

Will this plan cover my prescriptions when I’m away from home? (Yes or no)

You can use Worksheet 3 to compare Medicare Advantage health plans After You’ve decided to receive medical benefits from an MA plan rather than traditional Medicare (as explained in Chapter 9). This worksheet focuses only on medical care. You can get most of the answers by comparing Medicare health plans online at Www. medicare. gov. You may have to ask plans or providers for answers the online tool can’t provide. (To compare these plans’ drug benefits, use Worksheet 2.)

Worksheet 3 Comparing Medical Benefits in Medicare

Advantage Plans

Suggested Questions to Plan 1 Plan 2 Plan 3 Plan 4 Answer For Each Plan

Will the providers (doctors, hospitals) that I prefer accept this plan? (Yes or no)

Will this plan allow me to go to out-of-network providers for a higher co-pay? (Yes or no)

Will this plan cover my nonemergency healthcare needs outside of its service area? (Yes or no)

What will my fixed costs (monthly premium, annual deductible) be in this plan? (Dollar amounts)

Does this plan put a limit on my out-of-pocket expenses in a year? (Dollar amount) Are any services excluded from this limit? (Yes or no)

What will I pay to visit my primary care doctor in this plan? (Dollar amount or percentage)

Suggested Questions to Plan 1 Plan 2 Plan 3 Plan 4 Answer For Each Plan

What will I pay to visit a specialist in this plan? (Dollar amount or percentage)

What will I pay to stay in a hospital in this plan? (Dollar amount or percentage)

What are this plan’s ratings for quality of care? (pOor, FAir, GOod, VEry GOod, EXcellent)

Does this plan offer benefits for vision, hearing, or dental care? (Yes or no for V, h, Or D)

Does this plan offer preventive care (screenings, scans, tests) that meets my needs? (Yes or no)

Does this plan cover physical exams? (Yes or no)

Appendix B

The 5th Wave_By Rich Tennant

I think I’m having side ejects £rom my nevr prescription medication. I’m ieelino, nauseous and disoriented all day.’

In this part. . .

Am Ppendix A contains three worksheets that are useful ¥ 9 When you’re choosing a Part D plan. The first helps you create your master list of the prescription drugs you take now, plus their dosages and how often you take them. You can use the second and third worksheets to help compare drug plans and Medicare health plans point by point.

Appendix B is the place to go for contact information for many sources of help. Here you find phone numbers and Web site addresses for the key government agencies (Medicare and Social Security), every State Health Insurance Assistance Program, and many consumer organizations. This appendix also suggests ways of getting updates on Medicare and Part D so you can stay informed on changes that come down the track.

Appendix C is a guide on how to get prescription drugs Safely If you purchase them by mail order from Canada, where they generally cost less. It explains how to avoid scams and counterfeit meds, how to assess pharmacies for safe and ethical service, and how to find prescreened licensed pharmacies you can trust.

Appendix A