TUESDAY, NOVEMBER 2, 2010 CONSUMERREPORTSINSIGHTS Boomers, get ready forMedicare The first wave of baby boomers begins turning 65 in


January. Many might prefer to ignore that milestone, especially since Social Security has raised the full retirement age to 66 for that cohort. ButMedicare eligibility begins at 65, and it’s wise to get onboard immediately, even if you’re still working.Here are the most important do’s and don’ts.


DO SIGN UP FORMEDICARE BEFORE YOU TURN 65 Even if you are working and


have health benefits, you need to sign up for Medicare Part A, which covers hospital expenses. And when you sign up is impor- tant, especially if you need full coverage. The “initial enrollment period” forMedicare spans seven months: the three months before your 65th birthday, the month of your birthday, and the three months after that. But if you want your coverage to start on or be- fore your 65th birthday, sign up in that first three-month period. Waiting longer will delay your coverage.


DON’T DELAYMEDICARE PART B SIGNUP AFTER YOU STOPWORKING.


Medicare Part A is free to


anyone who has paid Medicare taxes for more than a decade or is married to someone who has. But there’s a monthly premium ($96.40 or $110.50 in 2010 for most people) for Part B, which covers most other medical ex- penses except prescription drugs. If you didn’t sign up for Part B whenyou should have, you will be hit with a harsh penalty: a perma- nent increase in your premium of 10 percent for every year that you


Inpartnership with


For further guidance, go to ConsumerReportsHealth.org, More detailed information—including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products—is available to subscribers to that site.


AnyBODY Carolyn Butler


Sometimes your brain has to cut across the grain This morning alone, I must


have made a million decisions: Should I grab the wailing baby from his crib, even though it’s still dark outside, or let him cry it out? What’s for breakfast? Do I have time to squeeze in a show- er? Should I try to fit in a work- out today? Do the boys need coats? Do I have enough gas to make it toGeorgetown and back? Should I turn left on to Volta Street to try to avoid running into the trash truck that I see on OStreet, or not? And that’s all beforemy first cup of coffee. If I actually stopped to think


about every last one of these choices, it would probably take me hours, if not days, to get out the door. Luckily, I don’t have to, thanks hundreds of simple rules, mental shortcuts and biases that hu- mans have developed over time, some of which we learn by expe- rience but many of which are now indelibly stamped into our neurons, allowing us to make split-second, automatic choices, most of the time. These gut in- stincts—which allow us to act instantaneously rather than stand paralyzed by the multitude of aforementioned decisions we have to make every day—are what psychologists call heuris- tics. For example, there is the well-


known and widely documented “familiarity heuristic,” which tells us that anything recogniz- able tends to be thought of as safe and good, and is supported by research showing that our brains process familiar and unfa- miliar situations and problems differently.Hence, I almost al- ways continue driving straight on 35th Street every morning, even though taking a turn or two could probably save me a few minutes. And I instinctively grab the same brand of tomato sauce at the market, despite the dozens of options lining the shelves. Sometimes going with your


gut makes sense—in the case of an emergency room doctor, say, who has to quickly diagnose an ailment he’s seen countless times before. But a newbook has forced me to reconsider allmy snap judgments and to wonder if perhaps I should take more time to considermy choices, particu- larly when it comes to important matters such as health, relation- ships and money. “We all live these heuristically


driven lives.We have these auto- matic processes in our minds


HEALTH & SCIENCE


group with a more confusing font, “the reading alone tired them out.” What that means, saysHer-


bert, director of science commu- nication for the Association for Psychological Science, a national organization based inWashing- ton, is that “people on the front lines of getting us through this national health and obesity crisis . . . have to overcome some really, really deeply wired habits of mind.” For example, he cites what he


terms the “visionary heuristic,” which he theorizes evolved from a time when hunter-gatherers had to conserve energy and which may influence how we viewphysical obstacles such as height, slope and size. A recent University of Virginia study sug- gested that people consistently perceive hills as steeper than they are, and steeper still if they are weighed down by a pack. So, he suggests, our brains conclude: Why begin the climb at all? “Most exercise is in one form


SHANE HARRISON


If I actually stopped to think about every last one of these choices, it would probably takemehours, if not days, to get out the door.


that have been there for a long time and are really difficult to dislodge—and they are impor- tant and serve lot of really good purposes, but when misapplied to social judgments and the mod- ern world, they can lead to peril- ous decisions,” saysWrayHer- bert, author of “On Second Thought: Outsmarting Your Mind’sHard-WiredHabits.”He speculates that these cognitive shortcuts helped our species sur- vive but that many have lingered in our brains long past the point of usefulness.Heuristics “are un- derstandable, from a scientific point of view, but that doesn’t mean they’re right.” Unfortunately, retraining your


mind to make better decisions is easier said than done. ButHer- bert’s theory is that the more we understand these ingrained im- pulses and recognize how nu- anced and pervasive they can be, the better we’ll be able to consid- er important choices. “Just that knowledge will give you the tools


to think about your thinking— to say, ‘I’mmaking a snap judg- ment here when I should be a lit- tle more deliberative and think it over,’ ” he explains. I couldn’t help but notice that


many of the 20 heuristics de- tailed in “On Second Thought” can relate to health. For example, take the familiarity bias a step further and you get the “fluency heuristic,” which tells us that if something is easy to process, then we tend to prefer it over more complicated options. In aUniversity ofMichigan


study cited byHerbert in his book, people were more open to the idea of working out and more likely to do it when the direc- tions for an exercise routine were written in a basic typeface as op- posed to a more convoluted script. “Apparently the [sub- jects’] brains mistook the ease of simply reading about exercise for ease of actually doing the sit-ups and bench presses,” writesHer- bert, who surmises that for the


or another a variation on climb- ing hills,” he writes. “So if we’re deep-wired to conserve energy, and specifically to avoid all but essential forms of work, that means there is a significant psy- chological disincentive to move at all, much less to hop on the StairMaster and climb for half an hour.” Of course, the science of heu-


ristics isn’t always so neat and tidy: There’s a lot of overlap and interaction between these cogni- tive rules of thumb, and people may process them differently. However,Herbert recommends at least one prescription for good decision-making that can help everyone: Carefully consider the timing of your most important choices. “Under any kind of stress, the


brain will default to our heuristic mind, because it’s a muscle that consumes glucose, and if that’s depleted or overtaxed, well, it’s much easier to default to auto- matic processes,” he explains. “So never make an important life de- cision when you’re tired or hun- gry, or if you have too many other things to do!” Which means that it’s proba-


bly okay for me to default tomy more primitive mind when mak- ing early-morning driving deci- sions but that I should definitely deliberate more carefully over the daily “Do I really need to work out today?” choice. health-science@washpost.com


Editor: Frances Stead Sellers • Assistant Editors: Margaret Shaprio, Nancy Szokan, Kathryn Tolbert • Art Director: Brad Walters • Editorial Aides: Charity Brown, Rachel Saslow • To contact us: E-mail: health-science@washpost.com Telephone: 202-334-7575


Mail: The Washington Post, Health, 1150 15th St. NW, Washington, D.C. 20071 • Advertising Information: Shawn Mckenna-Deane, 202-334-5750, mckenna-deanes@washpost.com FIBROMYALGIA


Weekly yoga classes and practicemay help relieve debilitating symptoms


THE QUESTION To ease chronic muscle pain and fatigue, people with fibromyalgia often are urged to exercise and develop coping skills, along with taking medication. Might yogahelp? THIS STUDY involved 53 women, with an average age of 54, who had had fibromyalgia for an average of about 12 years. They were randomly assigned to participate in weekly two- hour yoga classes tailored for peoplewith the condition or to be on a waiting list for the classes, which included gentle poses, meditation, breathing exercises, yoga-based coping instruction and group discussion.All the participants contin- uedtheirnormal care aswell,whichfor some includedtaking medication. Those in the yoga group were urged to practice daily at home, too. After eight weeks, standardized scales showed greater declines in pain, tenderness, fatigue, stiffness and depression, and bigger improvements in sleep,memory, balance, strength and vigor among the women practicing yoga. About 91 percent of the yoga group, compared with 19 percent of those on the waiting list, reported being better at theendof thestudythantheywereat thestart.Theyogagroup also changedtomoreproductive coping strategies fordealing with symptoms, relying on such things as problem-solving, religion, participating in activities despite pain, acceptance andrelaxation. WHOMAY BE AFFECTED?Women with fibromyalgia, charac- terized by widespread muscle pain and so-called tender points, are especially prone to painwith even slight pressure. Women with the condition are also extra tired andmay have headaches,morning stiffness, painfulmenstruation, tingling in hands and feet, and sometimes trouble with thinking and memory. The cause of fibromyalgia,which affects an estimat- ed 5 million people in the United States, mostly women, is unknown. CAVEATS Whether the findings apply to men and children, who also can develop fibromyalgia, was not tested. Much of thedata came fromthewomen’s recordedperceptionsof their symptoms. Participants were paid $25 for completing an assessmentat theendof thestudy.Thenumberofparticipants was small. FINDTHISSTUDYNovember issue ofPain. LEARNMOREABOUTfibromyalgiaatwww.niams.nih.govand www.mayoclinic.com.


—Linda Searing


The research described inQuick Study comes fromcredible, peer-re- viewed journals.Nonetheless, conclusive evidence about a treat- ment's effectiveness is rarely found in a single study. Anyone consid- ering changing or beginning treatment of any kind should consult with a physician.


could have signed up but didn’t. Even if they already have retiree coverage, most people should sign up either when they turn 65 or when they stop working, whichever comes later.


DO REALIZE THAT THE DRUG BENEFIT HAS ITS OWN RULES.


Part D, the Medicare prescrip- tion-drug benefit, is delivered ex- clusively through private plans, with an average premium of about $41 a month in 2011. As with Part B, you will pay a perma- nent premium penalty for late enrollment: 1 percent extra for every month that you could have enrolled but didn’t.


DON’T CONFUSE ORIGINAL MEDICARE ANDMEDICARE ADVANTAGE.


OriginalMedicare is the famil-


iar government-run plan that has been around since 1965. It has some substantial deductibles and coinsurance (for example, a $1,100 deductible for a hospital stay and 20 percent of outpatient doctor visits). People who don’t have a secondary retiree plan from their employer usually buy a separate private Medigap policy to help with Medicare’s deduct- ibles and coinsurance. And they must buy yet another stand-alone


plan if they want Part D. Medicare Advantage plans are


private plans that you can choose in place of originalMedicare. The vast majority are HMOs that re- quire you to get your care within a local provider network. A Medi- care Advantage plan substitutes for PartAand Part B (and in most cases also Part D). You can’t buy a Medigap plan if you are onMedi- care Advantage.


DO FIND OUT HOWYOUR RETIREE PLANWORKSWITH MEDICARE.


Some employers offer stand-


alone retiree plans, and some are the same as the active-employee plan; both types help cover ex- penses that are not paid through Medicare. Some employers offer additional options such as Medi- care Advantage plans.


DON’T ACCIDENTALLY LOCK YOURSELF OUT OFMEDIGAP COVERAGE.


In most locations you have the


right to buy a Medigap plan without medical screening only at certain times, such as when you first signupforMedicare or if your Medicare Advantage plan shuts down or you move out of its service area. For the Medigap rules in your


state, check online with your State Health Insurance Counsel- ing and Assistance Program at www.shiptalk.org.


DO RECHECK YOUR PLAN D FORMULARY EVERY YEAR.


All Part D plans have a formu-


lary, a list of covered drugs. But drug plans may change, with


certain drugs dropping off the formulary or moving to another payment tier. You can change to a new plan if your old one made changes you don’t like. Use the interactive formulary


finder at www.medicare.gov to find out which plans in your area cover your drugs and in what payment tier.


MEDICARE ADVANTAGE Consumer Reports Health re-


cently published rankings of 183 Medicare AdvantageHMOplans. The rankings were done by the nonprofit National Committee for Quality Assurance, the main U.S. group that sets measurement standards for health insurance, accredits plans and measures the quality of care they achieve. Not all HMOs are on the list, and Medicare Advantage PPOs are not yet ranked. Nationwide, the four topMedi-


care Advantage HMO plans each earned an overall score of 89 out of 100. The top plans in the Washington area were: l Kaiser Foundation Health


Plan of Mid-Atlantic States, which ranked 19th in the country, with a score of 86. l Aetna Health — Maryland,


ranked 64th, with a score of 82. l United Healthcare Insur-


ance Mid-Atlantic (serving the District and Virginia), ranked 87th, with a score of 80. Medicare also rates Medicare


Advantage plans on a five-star system. Those ratings can be found onMedicare’sWeb site. © Copyright 2010. Consumers Union of United States Inc.


HBO


The young people featured inHBO’s documentary rise above their limitations to show that they can be achievers.


EDUCATION ‘Disability’ isn’t in their dictionary


“I CAN’T DO THIS BUT I CAN DO THAT” (HBO) This 30-minute documentary focuses on children with learning differences and shows how they cope. As the title suggests, the theme is that although these kids may struggle in some areas, they excel in others. Joey is a 12-year-old with an auditory processing disorder, whichmakes it hard forhim to think and hear at thesametime. But he can paint stunning wall murals of knights and dragons. Almost all of the stories end positively, with the child switching into programs for learning differences. (The upbeat film doesn’t call them “disabilities.”) Check www.hbo.com for air times.


EXERCISE The downside of upside down


YOGA JOURNAL, NOVEMBER ISSUE Yoga teacher Patricia Sullivan shares a cautionary tale


about an injury she sustained practicing “the king of the asanas [poses]”: headstand. Numbness in her right hand turned to chronic pain, which a doctor confirmed was from her regimen of standing on her head for 10 minutes at a time. “My longing to excel . . . had led me to ignore my body’s signals and cries for relief,” she writes. Multiple sidebars to the article show safer ways to invert the body, such as lying with one’s legs up the wall.


—Rachel Saslow QUICK STUDY


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