0 Has my generic Lipitor been recalled?

Check your prescription container to see if a manufacturer is listed on the label. If your bottle says "Ranbaxy," call or take it back to the pharmacy where you filled the prescription to find out if it's been recalled. The pharmaceutical company Ranbaxy announced recently that it was recalling 41 lots of generic Lipitor (atorvastatin) due to concerns that they might contain small glass particles.

The Food and Drug Administration says the glass particles are so small they are unlikely to cause safety concerns, but the possibility of harm cannot be ruled out. Our medical advisers recommend that if your medication is included in the recall, return it to the pharmacy where you filled the prescription for an exchange. The recall affects 10 mg, 20 mg and 40 mg strengths of the drug, but not the 80 mg dose.

Pharmacy spokespeople at CVS and Costco told us they will work with customers to replace the recalled medication. Costco confirmed that there will be no charge to the patient. Walgreens and Target told us their pharmacy customers should not be affected, since they don't stock the Ranbaxy product that was recalled. Walmart and Kmart didn't return our requests for information.

Versions of generic Lipitor made by other manufacturers, including Apotex, Dr. Reddy's Lab, Mylan, Pfizer, and Watson, aren't affected by the recall. If there is not a manufacturer listed on your prescription bottle and you are unsure if your medication is part of the recall, contact your pharmacy.

Ranbaxy's generic Lipitor represents about 40 percent of the market for all medications, according to our Consumer Reports Best Buy Drugs internal analysis of prescription sales data. Some reports have expressed concern for a short-term shortage of atorvastatin while Ranbaxy works to remedy its manufacturing problems. But retailers we spoke with have made other arrangements.

"I don't anticipate a shortage and pharmacies can normally get another brand in stock within 24 hours," says Nate Eilers, RPh, of Costco.

The FDA has also said is does not expect a shortage will occur.

[Sources]
FDA Statement on the Ranbaxy Atorvastatin Recall [FDA]

Ranbaxy atorvastatin recall announcement [Ranbaxy]

Editor's note: Additional reporting and editing by Steve Mitchell.

0 CDC warns about bedbug pesticides

If you've got a bedbug infestation, you probably want to do whatever necessary to get rid of them, including spraying your home with pesticides. But earlier this week the Centers for Disease Control and Prevention warned about a steep rise in injuries from misuse of pesticides to control the bugs.

Health effects ranged from mild to serious, including one death. Using pesticides that are designed for outdoor use indoors or using too much pesticide were often the cause.

• If you have to use pesticides to kill bedbugs, consider this advice from the CDC:


• Follow all label instructions to the letter. Don't use outdoor pesticides inside your home and don't use more than recommended. This won't kill more bedbugs, but it might make you and your family seriously ill.


• Be careful who you hire. Treating bedbugs is not easy so you want someone who is experienced. Also be sure than any professional you use is licensed and certified to apply pesticides. You should get instructions on what's being used in your home. Ask to read label instructions. This applies to anyone your landlord hires as well.


• Signs of pesticide poisoning include headache, nausea, vomiting, diarrhea, dizziness, and muscle tremors. Children are particularly at risk because they are smaller and may put things in their mouths that have been covered in pesticide. If anyone in your home displays symptoms, seek advice and treatment from health professionals right away. Call your doctor or poison control center at 1-800-222-1222.


• Pet can also be harmed, and because of their smaller body size, may display symptoms before any humans do. So if your dog or cat seems sick after a pesticide application, that may be the first red flag that something is wrong. Call your veterinarian or the National Animal Poison Control Center at 1-888-426-4435.

Read more about how to keep bedbugs at bay.

Source
Health Concerns about Misuse of Pesticides for Bed Bug Control [CDC]

0 Medicare open enrollment: Did Obamacare secretly increase Part B premiums?

Q. I heard that the Medicare Part B premium was going to go up to $120 in 2013 and $247 in 2014 as part of Obamacare, and that this was kept under wraps so as not to influence the outcome of the 2012 election. True or false?

A. I've been sitting on this question for awhile awaiting the announcement of the 2013 Medicare Part B premium. Now it's time to answer. And the answer is that everything you heard was a fiction.

Per a law that has been in effect now for 15 years and has nothing whatsoever to do with the Affordable Care Act, every fall Medicare sets the Part B premium for the coming calendar year at a level that will cover exactly 25 percent of Part B's projected costs. So right off you can see that there is no way that the health reform law, enacted in 2010, could have set premiums three and four years in advance, which, once again, it did not.

Medicare recently announced what the 2013 Part B premium will be. It's $104.90 (not $120). This represents about a five percent increase over 2012's premium of $99.90.

You didn't ask, but should also be aware that higher-income Medicare beneficiaries must pay more than this standard Part B premium, thanks to the same 2003 law that established Medicare Advantage and the Part D prescription drug benefit. These higher premiums in 2013, by income level and filing status, will be:

• $146.90 for incomes between $85,001 and $107,000 (single) and between $170,001 and $214,000 (joint)
• $209.80 for incomes between $107,001 and $160,000 (single) and between $214,001 and $320,000 (joint)
• $272.70 for incomes between $160,001 and $214,000 (single) and $320,001 and $428,000 (joint)
• $335.80 for incomes above $214,000 (single) and $428,000 (joint)

Right now, about five percent of Medicare beneficiaries are paying these higher premiums. But in the next few years, that percentage is going to increase steadily, because of a provision that was put in the Affordable Care Act (but, needless to say, never a secret kept under wraps).

Here's what's happening. The 2003 law that set up these high-income premium surcharges also stated that the income thresholds were to increase every year to account for general inflation. But the Affordable Care Act freezes the thresholds at their current level through 2019, which will over the next six years snare more and more beneficiaries as incomes in general rise (or at least we hope they do). The Kaiser Family Foundation estimates that by 2019, about 14 percent of Medicare beneficiaries will be paying these higher premiums.

A silver lining in this scenario is that as of 2020, the freeze disappears and at that point, the income thresholds will be re-indexed to where they would have been if the freeze had never happened in the first place.

For more information, see our Health Insurance Buying Guide as well as rankings of health insurance plans.
Got a question for me? Ask it here.

0 FDA looking into safety of energy drinks

There's been a lot of buzz lately about the safety of energy drinks and shots. Following reports of harmful reactions and even deaths possibly associated with the products, two U.S. senators recently released a letter from the FDA stating that the agency is conducting a safety review of energy drinks and is considering requiring that labels disclose the amount of caffeine the products pack, limitations on use, and warnings about possible adverse effects. That makes sense, since our recent investigation found that the products sometimes have more caffeine than they claim.

"We support the FDA's investigation into the health effects of these products especially for vulnerable populations, including children, adolescents, those with heart problems and seniors," says Urvashi Rangan, Ph.D., director of consumer safety and sustainability at Consumer Reports. "We also believe that labeling is an important way to warn consumers of any potential dangers but that further action may be warranted based on FDA's findings."

Here's more news from the FDA's letter to U.S. Sens. Richard Blumenthal and Dick Durbin outlining the agency's actions and findings so far:

• FDA is probing whether energy drinks may pose significant risks arising from direct toxic effects when consumed in excess or by vulnerable groups, including young people and those with pre-existing cardiac or other conditions. The FDA said its review would likely include consultation with the Institute of Medicine, an advisory committee or other public meeting.
• FDA has yet to identify any safety studies that call into question the safety of combinations of various ingredients in energy drinks. However, it said that additive or synergistic effects of certain ingredients could be of concern. If stimulants, for instance, raise a significant safety question, FDA could require safety reviews.
• FDA disclosed that an in-depth analysis of caffeine consumption in the U.S. completed in August 2010 found that on average about 300 mg of caffeine, per person, per day is consumed. That's within the 400 mg per day limit that FDA has said is not associated with adverse effects in healthy adults. The report found that teens and young adults, age 14 to 21, consume only about 100 mg of caffeine per person per day, mainly from soft drinks, coffee, or tea. However, it said the data may not reveal possible extremes of consumption which alone or in addition to other factors could pose health risks, and that some smaller individuals may be more sensitive to caffeine's effects.
• FDA will consult with health profession groups about whether it is advisable for children and pregnant women to limit their caffeine consumption. It noted that the American Academy of Pediatrics recommends no more than 100 mg of caffeine per day for adolescents, but that the Institute of Medicine has said that stimulant-containing drinks and products have no place in the diets of children and adolescents because of the risk of physical dependence and withdrawal symptoms, such as sleepiness and irritability. The FDA noted that the United Kingdom's Food Standards Agency recommends that pregnant women consume no more than 200 mg of caffeine per day.

Bottom line: Reports of adverse effects and deaths possibly associated with some products by themselves don't prove the products caused the problems, the companies that responded to our requests for comment said, as did the FDA in a Nov. 16 press release. It's up to FDA investigators to assess the relationship, if any, between the products or ingredients and the reports, the agency said. But the FDA urged consumers thinking about taking energy drinks or shots to first consult a health care provider to ensure that they don't have an underlying or undiagnosed medical condition that could worsen as a result of their use. Consumers and health care providers should report adverse events they believe may be related to energy drinks and shots (or other FDA-regulated products) to the agency's MedWatch Adverse Event Reporting Program. Read our report in Consumer Reports.

Source
Blumenthal, Durbin: FDA Reviewing Safety Of Caffeinated Energy Drinks And Their Additives [Press release]

0 FDA shuts down Sunland peanut butter plant with new enforcement authority

The U.S. Food and Drug Administration has shuttered Sunland Inc.'s New Mexico plant after peanut butter made by the company was linked to an outbreak of Salmonella that sickened 41 people in 20 states.

The FDA suspended Sunland's food facility registration, prohibiting the company from distributing any products. This was the FDA's first use of its registration suspension authority under the Food Safety Modernization Act, which was enacted in January of last year. Without the enforcement authority, the FDA would have had to take Sunland to court in order to halt production and distribution at the plant.

In addition, according to the FDA, Sunland also has a history of violations that contributed to the federal agency's decision to suspend the company's registration.

"This is good news for consumers. FDA was able to act effectively and promptly to deal with a situation of a hazard in the marketplace," says Jean Halloran, director of Food Policy Initiatives for Consumer Reports. "This FDA action sends a powerful message to food processors that if you're producing in substandard conditions and putting out food that is hazardous to consumers, FDA will shut you down."

During plant inspections in September and October, the FDA found Salmonella in 28 samples from surfaces at the plant, in 13 product samples, and one sample of raw peanuts. Sunland's records showed that 11 product lots of nut butter showed the presence of Salmonella between June 2009 and September 2012. And between March 2010 and September 2012, at least a portion of eight product lots of nut butter that Sunland's testing program identified as containing Salmonella was distributed to consumers.

Last month, Sunland expanded a September recall of peanut products due to the Salmonella contamination.

The FDA will reinstate Sunland's registration when it determines that the company has implemented procedures to produce safe products.

Salmonella can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weak immune systems. Healthy people infected with Salmonella can experience fever, diarrhea, nausea, vomiting, and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses.

If you want an alternative for your kids' lunches read Make healthy school lunches your kids will love. For information about how to get involved with food safety, check out our website NotInMyFood.org.

Previously:
Peanut product recall expands due to Salmonella contamination
Trader Joe's peanut butter recall shows the need for tougher food safety regulations

Sources:
FDA Investigates Multistate Outbreak of Salmonella Bredeney Infections Linked to Peanut Butter made by Sunland Inc. [FDA]
The New FDA Food Safety Modernization Act (FSMA) [FDA]
Consumers Union praises FDA shutdown of Sunland plant, presses for further implementation of federal food-safety rules [Consumers Union]

0 Time for a whooping cough booster?

Pertussis, also known as whooping cough, is rising sharply and a new study suggests that a contributing cause may be that the vaccine now used loses effectiveness over time. Which means it may be time for you to get a booster.

The old vaccine, introduced in the late 1940s, dramatically reduced pertussis infections but was often associated with redness, swelling, pain at the injection site, and, in a few cases, serious complications. The current vaccine, which is called DTaP and also vaccinates against diphtheria and tetanus, was introduced in 1992 to reduce those risks.

Infants are most likely to be hospitalized and die from pertussis, but there's also been a sharp increase among school-aged children and even adults, according to the new study, which was published this week in the Journal of the American Medical Association. According to the study, California had its largest pertussis epidemic in 60 years in 2010, with more than 9,000 reported cases and 10 infant deaths. Researchers studied the vaccine records of children ages 4 to 10 and found that the longer the time since the final dose of the vaccine, the greater the risk of infection. That suggests that the vaccine loses effectiveness over time.

Despite whooping cough's recent resurgence, cases are still far below what they were in the pre-vaccine era. Another finding from the JAMA study: unvaccinated children were nine times more likely to contract pertussis than were their immunized peers.

Bottom line: Researchers may eventually recommend a different vaccination schedule or develop a longer lasting vaccine. But for now, the DTaP vaccine offers substantial protection against whooping cough. The vaccine is actually a series of five shots, all of which must be completed in order for it to be most protective. Children should receive doses one through three before their first birthday, dose four between by 18 months old, and dose five between ages 4 and 6 . An adolescent booster, Tdap, should be administered at age 11. Pregnant women should also get a shot, as should people 65 and older who are in contact with infants. For details, see our advice on vaccines for children and adults. And see the CDC's pertussis website.

Source
Association of childhood pertussis with receipt of 5 doses of pertussis vaccine by time since last vaccine dose, California, 2010 [JAMA]

0 Stay safe online on Cyber Monday

Don't want to brave the lines, crowds, and general pandemonium of Black Friday? You could always stay home and shop online on Cyber Monday instead. Many online retailers will be offering substantial discounts, free shipping, and other attractive perqs to Web shoppers on the Monday after Black Fridaythat's November 26 this year.

Here are some tips for safe online shopping:

• Never use the same password for multiple sites. Minimize the chance that a hacker who broke into one account can gain access to your other online accounts.


• Create and use separate e-mail addresses. Specific e-mail accounts for specific shopping sitessay, "MyAmazonAccount@gmail.com"will limit your data exposure when a particular online retailer gets hacked.


• Never use any part of your name or any other easily guessed word in your password.


• Use a strong password, including a mixture of letters, numbers, and special characters. Substituting numbers for letters might help you remember your login--"pa55w0rd" instead of "password," for example. And some websites allow the use of symbols such as ! and . For more password advice, see "How to create a strong password (and remember it!)."


• Verify that the site you're doing business with is a known and trusted retailer.

Make sure to check out any electronics devices you're thinking of buying in our Ratings at ConsumerReports.org. And for more ways on how to protect your money and information online, see our guide to online security.

Related:
Fake online product reviews draw regulator attention
Electronics store buying guide
Computer store buying guide
Naughty or Nice? See which companies made our list this year and why
Consumer Reports' Holiday Gift Guide 2012

0 Meningitis cases from tainted steroids continue to rise

The outbreak of fungal meningitis due to a contaminated steroid has affected 490 people and caused 34 deaths, according to updated figures released earlier this week from the Centers for Disease Control and Prevention. Our medical advisers say the ongoing rise in cases means people who received a tainted injection and who feel fine should continue to watch for any signs of infection. It also underscores our advice to avoid using medication from compounding pharmacies if possible, and to turn to steroid injections for back pain only after trying other treatments.

The fungal meningitis cases stem from three contaminated batches of the steroid methylprednisolone acetate (MPA) made by New England Compounding Center in Framingham, Mass. Thousands of people across 23 states received epidural shots of the contaminated batches of steroids to treat pain. Most of the 490 cases consisted of meningitis (an infection of the brain or spinal cord) following treatment for back pain, but there have also been cases of infections following injections in the elbow, hip, knee, and shoulder.

Doctors have been instructed to contact people who received contaminated shots, but if you think you may have received a tainted injection and you haven't been contacted, check the CDC list of facilities to see if it includes the clinic you visited. If it does, double-check with your doctor whether your injection came from one of the recalled batches. The CDC has also an online map that shows the states affected.

If you received an epidural steroid injection from one of the listed clinics since May 21, 2012, be alert for any symptoms that could signal a fungal infection. Those include:

• fever


• increased pain, redness or swelling at your injection site


• new or worsening headache


• sensitivity to light


• slurred speech


• stiff neck


• weakness or numbness in any part of your body

If you experience any of those, talk to your doctor as soon as possible. The CDC has additional advice on what to do if you think you received a tainted injection.

To reduce your risk in the future, our medical advisers recommend that you only use a medication from a compounding pharmacy if no other FDA-approved product is available. Also, in most cases of back pain, you should start with simpler measures, such as over-the-counter pain relievers, physical therapy, and exercise, before turning to steroid shots.

[Sources]
Multistate Fungal Meningitis Outbreak Investigation [Centers for Disease Control and Prevention]

Is it OK to use a compounding pharmacy? (And what is one anyway?) [Consumer Reports]

Should you avoid all steroid injections for your back pain? [Consumer Reports]

0 One-third of shoppers to hit the malls or keyboard on Black Friday

With just over a month until Christmas, 57 percent of consumers (and 65 percent of men) have yet to begin shopping, mostly because they think they have plenty of time, according to the latest Consumer Reports Holiday poll. However, in yet another reminder of ongoing tough times, 17 percent said they've delayed shopping because they just don't have enough money.

Despite the economic upheaval of the past four years, most Americans are anxiously awaiting the holidays. Thirty-seven percent of those surveyed said they're looking forward to them; another 26 percent are really looking forward to celebrating the holidays. Nevertheless, there are always a few Scrooges among us. Six percent of respondents said they're not looking forward to the holidays at all.

Neither the state of the economy nor the recent presidential election is affecting cheerfulness one way or the other. Sixty-seven percent of respondents expect to be just as happy this year as in 2011.

The poll, a nationally representative telephone survey of 1,557 adults 18 and older, reveals that since the recession many Americans have changed their behavior - spending more conservatively, and giving fewer and less-lavish gifts. Indeed, the gifts people are considering this year skew to the practical: clothing, cited by 52 percent of respondents, gift cards (46 percent), toys (39 percent) cash or check (37 percent), and books (31 percent).

With shopping as much a part of the season as eggnog and holiday music, expect millions to be out in force on Black Friday weekend. Thirty-two percent of respondents say they'll hit the stores; 34 percent intend to shop online, the same percentage that plan to order online from the office on Nov. 26 to participate in the phenomenon known as "Cyber Monday."

Since the economy tanked in 2008, half of those surveyed said they're spending less than they did before the recession. Forty-seven percent have economized by buying cheaper gifts; 36 are purchasing fewer presents. Six percent have replaced store-bought items with handmade ones to save money. For the upcoming season, 37 percent of respondents said they intend to spend less than they did in 2011 (only 12 percent indicated they'll spend more).

Budgeting will play a big role this year, too. Fifty-two percent plan to make a holiday spending budget. Hopefully, they'll do a better job living within it. In 2011, one-third of the 41 percent who set a budget exceeded their spending limit; four percent went way over budget.

One problem that hasn't disappeared is holiday debt. Half of shoppers charged gift purchases last year and 13 percent are still paying off credit card debt from those purchases.

While gift cards continue to be desirable, 15 percent of people still have at least one unused card from 2011.When asked why the cards haven't been spent, 29 percent said they haven't had time to use the card; 24 percent indicated they couldn't find anything they wanted to buy; and 23 percent (30 percent of men) simply forgot about the card. Seven percent cited the fact that the card came from a store they didn't like.

Wondering what some of the hot electronics gifts will be? High on the list of those surveyed include: the Amazon Kindle Fire, Apple iPod, iPad mini, and iPhone 5, LeapFrog LeapPad2 Explorer, Nintendo Wii U, Samsung Galaxy S III, and Apple MacBook Air. Among toys: Hasbro's Furby, Barbie Photo Fashion Doll, and Lego Ninjago Epic Dragon Battle.

We recently named the Kindle Fire, iPhone 5, and Galaxy S III standout performers. Find out which other devices are included in our 10 top electronics products review.

Tod Marks

0 Hot cocoa makers recalled due to possible lead risk

Focus Products Group International, which owns the West Bend brand name, is recalling several hot cocoa drink makers today. According to the Food and Drug Administration, the small appliances have internal parts that may leach heavy metal lead while making hot cocoa.

Although there have been no reported illnesses or deaths tied to the recall, safety experts warn that the lead-leaching can be dangerousespecially to young children. Exposure to heavy metals, such as lead and cadmium, may bring irreversible health effects such as anemia, kidney damage, and brain damage.

In May, the Centers for Disease Control and Prevention had lowered the allowable blood lead-levels for children, due to concerns that their developing bodies can more-readily absorb and retain toxic heavy metals.

Read "CDC advisers call for less allowable lead" and our buying advice for lead testing kits for more information on how to reduce your child's lead exposure and prevent lead poisoning.

Today's recall involves the following Cocoa Latte Hot Drink Maker models, sold nationwide at retailers such as Bed, Bath & Beyond and Amazon.com from 2004 through October 12, 2012:

Make	Model Number
West Bend	65032
Back to Basics	CM300BK CM300BKL CM300BLSS CM300BR CM300BRBRL CM300BRL CM300W

Consumers are urged to immediately stop using the recalled Cocoa Latte Hot Drink Maker and contact Focus Products' Call Center (toll-free: 888-943-5202) for instructions to obtain a free replacement hot cocoa maker.

Sources:
Focus Products Group International, LLC Announces a Nationwide Recall of Cocoa Latte Hot Drink Maker [FDA]
Nationwide Recall of Cocoa Latte Hot Drink Makers Due to Possible Lead Risk [Focus Products Group International]
Product recall information [West Bend]

0 Is it OK to use a compounding pharmacy? (And what is one anyway?)

A: Until other much-needed changes occur, you should only use a medication from a compounding pharmacy if no other FDA-approved product is available, say our medical advisers. Compounding pharmacies create individual, customized drugs. They can, for example, omit ingredients such as lactose or gluten for people with allergies, flavor drugs to make them easier to take, create lower doses for children, or prepare a liquid, dissolvable lozenge, or suppository for those who can't swallow a capsule.

The national meningitis outbreak, which has sickened at least 451 people and claimed the lives of 32, has heightened concern about the safety of compounding pharmacies. There are 7,500 in the U.S., plus about 8,200 associated with hospitals and other health institutions. They are mostly regulated by state pharmacy boards, whose rules vary. The Food and Drug Administration cooperates in investigations and follow-up actions, but it has limited oversight of the pharmacies, according to a recent Congressional Research Service report.

"Regulation of compounding pharmacies by state boards of pharmacy is not uniform throughout this country and it should be," says Marvin M. Lipman, M.D., chief medical adviser for Consumer Reports. "In addition, all large-scale compounding pharmacies should be under the purview of the FDA before another tragedy occurs."

The drugs implicated in the current crisis came from a single pharmacy, the New England Compounding Pharmacy, which compounded more than 17,000 doses of the potentially tainted steroids and shipped it to 76 healthcare facilities--where an estimated 14,000 patients received the injections to treat pain. By compounding so much medication, the "pharmacy was behaving more like a drug manufacturer. Instead, compounding is meant to respond to individual patient needs on a small scale," says Cynthia Reilly, B.S. Pharm, director of the practice development division of the American Society of Health-System Pharmacists.

Clinics and hospitals might purchase compounded medications when there is a shortage of a certain drug and it becomes difficult to obtain a standard version from a distributor or manufacturer. In other cases, compounders may create a less expensive version of an FDA-approved drug without having to meet the agency's strict manufacturing standards.

The major risk from compounding lies with drugs that are injected, delivered through an intravenous (IV) line, used in the eyes, or inhaled through a nebulizer. Such medications must be completely germ-free in order to prevent infection, and the meningitis tragedy demonstrates the harm that can occur if they're not.

If you are scheduled to receive an intravenous, joint or spinal injection, ask if the material was compounded and whether the compounding pharmacy is accredited by the Pharmacy Compounding Accreditation Board (PCAB). That advice also applies if you receive injectable eye medication or eye drops in connection with an eye operation or procedure. "In light of the current situation, health-care providers will be expecting to hear these questions much more frequently," says Reilly.

For all other medications, if your doctor prescribes a drug compounded especially for you, ask if a standard FDA-approved formulation is available and appropriate for your treatment instead. But if not, "consumers shouldn't be afraid to use a compounding pharmacy if they need a product that's not available, such as an ointment instead of a pill, and they have a prescription from their physician for it," says Allen Vaida, PharmD, executive vice-president of the Institute for Safe Medication Practices.

[Additional links]
Steroid injections for back pain: Worth a shot? (Consumer Reports)

Relief for your aching back: What worked for our readers (Consumer Reports)

Death toll from contaminated shots rises (Consumer Reports)

0 Open enrollment: My income is really low. Can I get help paying for health care?

Q. I am 68 and have only Medicare Part A. My sole source of income is $1,062 a month from Social Security. I'm in good health but concerned about future medical needs. Are there any plans for lower-income people?

A.Yes, and it's a shame more Medicare beneficiaries don't know about them. It's understandable why they don't, as these programs are complex, vary from state to state, and seem to have been designed so everything about them is as baffling as possible.

But let's give it a shot anyway.

We'll start with a program that helps lower-income Medicare beneficiaries pay premiums and out-of-pocket costs for Medicare Parts A and B. Its overall name is the Medicare Savings Program (MSP), and it has several different benefit levels for people with different financial resources. At its most generous the program will pay your Part B premium and pretty much all your Medicare deductibles and coinsurance. At its least generous the program will pay just your Part B premium. (In situations like yours, where you didn't sign up for Part B when first eligible, the program will also pay the 10 percent premium penalty you'll be assessed for every year you could have enrolled, but did not.)

How poor, exactly, do you have to be to qualify for a MSP? The minimum standard, set by Medicare, is an income under 135 percent of the federal poverty level, which at the moment works out to $1,277 a month for individuals. "Everything counts towards income, including payouts from 401(k) plans, pensions, Social Security, and help from family members," says Brandy Bauer, communications manager at the National Council on Aging. Medicare also allows states to impose an asset test, which can be as little as $6,940 per individual (not counting your house or car but counting retirement savings and bank accounts).

But some states have made their MSP programs a lot more generous, with much higher income limits and in some cases no asset tests at all. And the program may be called something else in your state.

"In most states, nobody will automatically let you know you qualify," says Mitchell Clark, a media spokesperson for the Medicare Rights Center. "You have to actively apply." The place to apply is your state's Medicaid office, which you can find a link to at Medicaid.gov.

There is another completely separate program that helps with prescription drugs. Continuing with the theme of maximum confusingness, it has two names, Low-Income Subsidy and Extra Help, for no apparent reason. And to get it, you apply through your local Social Security office, not your Medicaid office.

Depending on exactly how low your income is, the program will pay all or part of your Part D prescription drug plan premium and deductible, a hefty chunk of your copay, and totally eliminate the infamous doughnut hole. In 2013, individuals with an income of up to $1,398 a month can qualify for Extra Help. There are also asset limitations.

If you manage to get yourself into a Medicare Savings Program, you will automatically qualify for Extra Help. But because the requirements are slightly different, even if you don't qualify for a Medicare Savings Program for Part B you might be able to get Extra Help for Part D.

Right now you're probably about to give up because you have no idea whether you might qualify for any of this. Happily, the National Council on Aging has created an invaluable online interactive tool, BenefitsCheckUp, to do the work for you. If you answer all the questions, it will in the end not only tell you which programs you may qualify for, but provide downloadable application forms and, in the case of Extra Help, allow you to complete your entire application online. The program even knows the specific MSP eligibility rules in your state.

Or, if you'd prefer interacting with an actual human being, you can start by contacting your State Health Insurance Assistance Program, a free personal counseling service for Medicare beneficiaries. Here's a list of programs by state.

For more information, see our Health Insurance Buying Guide as well as rankings of health insurance plans.
Got a question for me? Ask it here.

0 Medicare open enrollment: Sandy victims get an extension

Medicare beneficiaries whose lives have been upended by Hurricane Sandy will be allowed to sign up for Medicare health and drug plans after the open enrollment deadline of Dec. 7, the Centers for Medicare and Medicaid Services has announced.

If you don't plan to change your Medicare Advantage or Medicare Part D drug plan for 2013, you don't have to worry about the deadline at all as you will be automatically re-enrolled in you current plan.

If you do want to make a change, CMS would still like you to hit the December 7 deadline if you possibly can. But if you can't because of the big storm, you can enroll as soon as you're able by calling 1-800-MEDICARE (1-800-633-4227). Your new coverage will start Jan. 1, 2013 if you sign up before the end of December. If it's later than that, coverage in most cases will start at the beginning of the next month.

CMS said it is taking people's word for whether they were affected by Hurricane Sandy, including individuals "who don't live in the affected area but rely on help making healthcare decisions from friends or family members who do."

For more information, see our Health Insurance Buying Guide as well as rankings of health insurance plans.
Got a question for me? Ask it here.

0 iPhone, Droid smarter picks than BlackBerry for people with allergies

In case BlackBerry users needed another reason to upgrade to a newer smart phone, research released today suggests there could be a health benefit to doing so, at least for people with skin allergies.

In a small study presented at the annual scientific meeting of the American College of Allergy, Asthma and Immunology, researchers measured the levels of cobalt and nickeltwo metals that can cause itchy allergic reactions in susceptible peoplein 72 cell phones, including 25 iPhones, 17 Motorola Droids, 9 BlackBerries, and 21 older-style flip phones. None of the iPhones or Droids tested positive for either cobalt or nickel, compared with 29 percent of BlackBerries that tested positive for nickel (none of them had detectable levels of cobalt). The presence of potentially allergenic metals was even higher among flip phones: 91 percent of them tested positive for nickel and 52 percent contained cobalt.

The researchers note that hypersensitivity to metals is on the rise, though more research is needed to determine whether metals in cell phones contribute to the development of such allergies, especially facial dermatitis (marked by itchy, dry skin in the area that's come into contact with an allergen).

In the meantime, although the study was small and not yet published, it probably makes sense for people with known allergies to use a non-BlackBerry smart phone, especially if they've noticed facial symptoms after using one of the phones found to contain metal.

If you're thinking of upgrading, check our smart phone Ratings to see how current models fared in our tests.

Source
Blackberry vs. iPhone. There is a Winner, for your Health. [American College of Allergy, Asthma, and Immunology]

0 Hurricane and nor'easter dramatize role of flood insurance

The one-two punch of last week's Superstorm Sandy and yesterday's nameless nor'easter is likely to put flood insurance on many East Coast consumers' shopping lists, joining generators, bottled water, batteries, and plane tickets the heck outta here.

Unfortunately, unlike those other items, flood coverage is generally subject to a 30-day waiting period, so a policy bought today typically won't provide protection until a month from now. (FloodSmart.gov, the website of the National Flood Insurance Program, describes the few exceptions to the 30-day rule, along with other details.) Still, if your home is in danger of flooding, a peril typically excluded from traditional homeowners insurance policies, flood coverage could be money very well spent.

Some basics:

• Flood insurance is a federal program, though policies are sold through private insurance companies and agents.


• Coverage is capped at $250,000 per residential dwelling and $100,000 for contents.


• Costs vary by risk of flooding. You can get an estimate for where you live, as well as a list of local agents, by typing your address into the NFIP's One-Step Flood Risk Profile.

Our short video Should you buy flood insurance? also answers many of the basic questions.

Related:
Homeowners insurance buying guide
Generator buying guide

0 Popping a daily multivitamin doesn't prevent heart attacks, study finds

Do you think of taking a daily multivitamin as a form of "health insurance"? More evidence suggests that you may be wasting your money.

Researchers at Brigham and Women's Hospital and the Harvard Medical School gave either a multivitamin or a placebo to about 15,000 male physicians, from 1997 to 2011. Over that time, the men who took the vitamin had the same rate of heart attacks, strokes, and other forms of cardiovascular disease as those who took a placebo. The study was published this week in the Journal of the American Medical Association.

The study's authors worried that people who take daily multis may think that the vitamins provide enough protection to offset healthy behaviors. They also cited concerns about how much money Americans spend on the vitamins. Sales of multivitamins are in the billions each year.

Our medical experts share those concerns. "How much evidence is really needed to convince the millions of Americans who, with military exactitude, pop a daily multivitamin?" says Marvin M. Lipman, M.D., Consumer Reports' Chief Medical Adviser. "Multiple well-controlled studies involving large populations showing the uselessness of supplemental single vitamins and multivitamins have more than countered the advertising and wishful label claims of those products. We should wake up and realize that, genetics aside, lifestyle changes in our diet and exercise patterns are the prime determinants of good health."

Last month the same study suggested that multis might help protect against cancer. But as we pointed out then, the benefit was modest at best, and man other studies had failed to find similar results. For details, see our recent report 10 Surprising Dangers of Vitamins.

So we continue to recommend that when possible you get your nutrients from foods. If you do need more of certain nutrients, like calcium and vitamin D, we think it's usually better to get that from specific supplements rather than from a multi.

People who might need a multivitamin include women who are pregnant, breast-feeding, or trying to conceive; dieters consuming fewer than 1,200 calories a day or cutting out an entire food group (carbs, for example); strict vegetarians; and those with medical conditions that affect digestion and food absorption. For more detailed advice, see our Ratings of multivitamins.

Note that our Ratings found that most of the multis we tested contained what they claimed, so we advise that if you do opt for the pills you choose by price, not brand. Centrum Silver, the brand used in this study, was near the middle of the pack in price. Kirkland Signature Daily Multi (Costco) and Equate Complete Multivitamin (Walmart) were the least expensive.

Source
Multivitamins in the Prevention of Cardiovascular Disease in Men: The Physicians' Health Study II Randomized Controlled Trial

0 Bypass surgery beats angioplasty for people with diabetes

For almost two decades research has suggested that people with diabetes and multiple clogged arteries live longer and have fewer heart attacks if they undergo bypass surgery instead of angioplasty. Yet many of those people continue to be treated by angioplasty, since many doctors remain unaware of the evidence, or unconvinced by it. Now a major new study, out this week in the New England Journal of Medicine should finally settle the matter in bypass's favor.

In the new study, researchers divided 1,900 people with diabetes plus multiple clogged arteries into two groups. About half underwent coronary artery bypass graft surgery (CABG), in which heart surgeons cut out the blocked section of artery and replace it with a length of healthy artery taken from elsewhere in the body. The other half underwent angioplasty (also called percutaneous coronary intervention, or PCI), in which an interventional cardiologist snakes a balloon up into the clogged section of the coronary artery, inflates it to push the blockage aside, and then leaves a cylindrical, drug-coated metal stent behind to keep the artery propped open. It was the largest such study to date, using the most up-to-date and accepted practices for each.

After five years, 18.7 percent of the bypass patients had died or had a heart attack or stroke, compared with 26.6 percent of those who underwent angioplasty. That represents an impressive 30 percent reduced risk for bypass surgery over angioplasty. The finding jibes with many earlier, smaller prior studies.

An editorial accompanying the study concluded that it "provides compelling evidence of the comparative effectiveness of CABG versus PCI in patients with diabetes multivessel coronary artery disease." And it also points out that one reason angioplasty rates continue to be so high is that doctors often rush patients into the procedure without fully explaining it's limitations.

That is a problem we have long warned heart patients about. For details, see our story, Too Much Angioplasty. If you do need bypass surgery, use our heart surgeon Ratings to find a practice in your community with low complication and high success rates.

Sources
Strategies for Multivessel Revascularization in Patients with Diabetes [New England Journal of Medicine]

Compelling Evidence for Coronary-Bypass Surgery in Patients with Diabetes [New England Journal of Medicine]

0 Tips for a smooth transition on Bank Transfer Day

Today is Bank Transfer Day, which encourages you to switch your money to a credit union or smaller bank if you are unhappy with your current bank.

According to a Consumer Reports survey this past summer, nearly one-fifth of all consumers with checking accounts considered switching to a new financial institution over the previous 12 months.

"Consumer frustration has only grown over the past year as bank fees have continued to rise," says Suzanne Martindale, staff attorney for Consumer Union, the advocacy arm of Consumer Reports. "But many frustrated consumers end up staying with their bank because switching to a new financial institution can turn into a big hassle."

Consumers Union renewed its call for Congress and the Consumer Financial Protection Bureau to enact reforms that would make it easier for consumers to move their money to a new financial institution. "It's time to make it easier for consumers to move their money so they have a real choice when it comes to where to bank," says Martindale.

You're more likely to find lower fees and better rates at community banks, larger credit unions, and online institutions.

Tips to help guide you to a new bank:

1. Open your new bank account with a small deposit, leaving the bulk of your funds with your old bank. Deposit just enough to avoid any fees you may be charged for maintaining a low balance.
   
2. Next, make a list of all the automatic payments and deposits scheduled to go in and out of your old account each month. If you have direct deposit, ask your employer to reroute your paychecks to your new account. Find out what date the first deposit will occur, then reschedule each automatic payment or debit to come out of your new account and make sure to ask the company what date the change will apply.
   
3. Leave some cash in your old account for at least one month.
   
4. Once you are sure that all automatic payments and all direct deposits are coming and going from your new account, electronically transfer the final funds from your old account.
   
5. Once the transfer clears, follow the procedure laid out by your old bank to close your account. If you don't close it, you might get hit with a monthly account maintenance fee even after you stop using it. Get written confirmation that the account is closed.

For more read our report on how to fight back or flee when facing more fees and what to do if you're being nickeled-and-dimed by your bank.

0 Hurricane Sandy proves cash is still king in emergencies

The widespread and ongoing power outages caused by Hurricane Sandy not only left millions of people in the dark but reminded many of us of how useful it can be to have some good, old-fashioned cash on hand for an emergency.

Many ATMs in Sandy's path were rendered useless by the storm. Those that remained in operation often had long lines, and some reportedly ran out of cash. Credit and debit cards weren't of much use either, dependent as they are on electronic store terminals.

So, before the next big storm, it may make sense to round up a little extra cash. Some advice from our money experts:

• If you want to conceal cash in a safe place at home, it's easy enough to make one. For example, put a roll of bills into an empty food can and stow it deep in your pantry or hollow out that copy of "Moby Dick" you know you'll never read anyhow. Burglars have seen it all, of course, but they're usually in too big a hurry to check every book or canned good you own. If you're not the do-it-yourself type, you can buy similar items, such as wall clocks with secret compartments and Pringles tubes with fake bottoms.
• Consider a home safe. Safes are designed to protect their contents from fire, burglary, water, or some combination of those perils. So your first step is to decide what risks you're most concerned about. You can find safes at retailers such as Costco, Home Depot, Lowe's, Sears, and Target, as well at specialty stores and online. Expect to pay $50 for a small chest suitable for stowing cash or $100 and up for a safe large enough to accommodate other valuables and important documents. Consumer Reports doesn't test them, but our Money Adviser newsletter has published a guide to choosing and using a home safe.
• Finally, and obvious as it seems, if you hide money around the house, try not to forget where you put it.

0 Consumer Reports Index: Americans see major decline in financial difficulties

The Consumer Reports Index, an overall measure of Americans' personal financial health, revealed a major decline in the financial difficulties faced by consumers and a rise in consumer sentiment ahead of the election and winter holidays.

The Consumer Reports Index comprises five measures: Employment, Retail, Sentiment, Stress, and the Trouble Tracker.

The Trouble Tracker, a gauge of financial difficulties, was at its lowest level since first measured in April 2009, declining from 50.2 last month to 38.7. The largest improvement was among those earning $50,000 or more, although lower-income Americans also saw modest improvement.

The Index's sentiment measure pushed into positive territory (50.7), propelled by gains among Americans earning $100,000 or more, whose sentiment improved 6.7 points to 59.7 percent. Americans earning less than $50,000 saw only a modest rise, although their sentiment remained in negative territory at 48.2 (up from 46.5 last month).

"There is reason for optimism this month, with financial difficulties in decline and sentiment moving upward. These are very heartening signs for retailers, especially as we get into the all-important holiday shopping season," says Ed Farrell, director of consumer insight at the Consumer Reports National Research Center.

The Index's employment measure also reached a high point this month, 51.5, up from 49.7 last monthits highest level since first measured in April 2009. In the past 30 days, more Americans started rather than lost a job. However, job starts remained at relatively low levels. "Continued progress will hinge on increasing job starts over the coming months to sustain gains," says Farrell.

The Index's past 30-day retail measure was down slightly this month (9.6 from 10.6 last month), but was up slightly from a year ago (9.1). However, the next 30-day retail measure, which reflects planned activity for November, showed gains across most categories, and was led by items usually popular as holiday gifts such as personal electronics (21.4 percent, up from 15.9 percent last month) and small appliances (13.8 percent, up from 9.3 percent).

The level of stress that consumers reported was virtually unchanged from last month (57.8 from 58.0).

The Consumer Reports Index, a monthly telephone poll of a nationally representative sample of American adults, is conducted by the Consumer Reports National Research Center. A total of 1,013 interviews were completed between Oct. 25 and 28. The margin of error is +/-3.2 percentage points at a 95 percent confidence level.

Previously:
Last month's Consumer Reports Index: Financial troubles grow for middle-income Americans

0 FTC cracks down on robocalls hawking deceptive credit card rates

Consumers Union, the policy and advocacy arm of Consumer Reports, praised the Federal Trade Commission's legal action today against five companies accused of making millions of illegal prerecorded calls to pitch allegedly deceptive offers of reducing credit-card interest rates in exchange for staggering upfront fees.

The FTC said the telemarketer calls sometimes identified themselves as "Cardholder Services," suggesting they were associated with your bank or credit card company. The telemarketers guaranteed a lower rate, but then did little to nothing to secure that rate. The upfront fees ranged from several hundred dollars to nearly $3,000.

"We're glad [the FTC is] taking a hard line against shady robocalls that may be trying to scam you with phony offers," says Ellen Bloom, Director of Federal Policy for Consumers Union. "The complaints against these companies suggest a level of deception that is absolutely shameless."

If you get a robocall hang up. Don't press 1 to get an operator, and don't press any other number to get off the robocaller's list, because that will probably just lead to more calls. You can add your number to the do-not-call list for free, sign up at National Do Not Call Registry, or call 888-382-1222 from the number you want removed. Granted, being on the do-not-call-list does not always save you from these annoying calls, as we've reported before.

If you're in the market for a new home phone, our cordless phone Ratings include models with caller ID.

To find the best credit card for your spending needs, read our recent report on 53 popular credit cards, plus our guide to credit cards.

To report a robocall to the FTC visit the agency's Complaint Assistant, or call 877-382-4357.

Sources:
FTC Leads Joint Law Enforcement Effort Against Companies That Allegedly Made Deceptive "Cardholder Services" Robocalls [FTC]
Consumers Union praises FTC crackdown on "Cardholder Services" robocalls [Consumers Union]

0 Coping with the emotional aftermath of Hurricane Sandy

One of the frustrations of Hurricane Sandy is that even our best efforts could not prevent a huge amount of destruction. Consider my friend Adam Wexler, owner of Resolution Audio Video in the waterfront section of Red Hook in Brooklyn. Before the storm he moved all his equipment up to 5 foot high scaffolding and thought it was safe. But when he arrived at work on Tuesday, he found the steel doors to his building had been caved in by the force of the water, which reached a high water mark of 8 feet. His equipment was scattered and soaked.

As a clinical psychologist, I urge Adam and the millions of others affected by the hurricane to take a little time to acknowledge the internal turmoil caused by the days and possibly weeks of heightened stress. Don't be dismissive of your own situation, even if it's so much less horrific than the TV images of towns washed away and entire city blocks burnt to the ground. The more mundane after-effects such as power outages, downed trees, and difficult commutes, are also highly stressful. Everyone experiences and copes with trauma in different ways. Here are a variety of approaches, which I've found effective working with clients suffering traumatic events, that you can keep in mind as you deal with the aftermath of the hurricane.

Acknowledge your feelings. Whether you have lost your home, or have been deeply affected by watching images of these terrible events, you will have an emotional response. Research has shown that acknowledging and talking about your feelings immediately following a traumatic event can reduce the likelihood of later development of trauma-related disorders.

Take some time to process the events. Processing a traumatic event can include talking with friends, writing in a diary, or talking with a mental health professional. Support groups are often available in areas affected by major disasters. The state of New Jersey has crisis help information available. Social media is a newer resource that many have access to using a smartphone during power outages. This is a useful way to connect with friends and family and share your experiences if you do not have access to in-person support.

Take a moment to observe the positive. As we get caught up in meeting our basic needs, and counting our losses, we also need to observe the amazing cooperation and kindness occurring all around us. Step back and watch children play, enjoy a moment of sunshine, or focus on acts of selflessness. My friend Adam, for example, has been moved by the support of others. "This experience has allowed me to meet and work together with fellow business owners, creating a tighter community among the local community," he says. "The equipment can be replaced but no storm can wash away the feelings of love and support I've experienced."

Find productive ways to deal with feelings of guilt or sorrow. It's not uncommon for those relatively unaffected by disasters to experience guilt and sorrow. These feelings should be acknowledged as well. If you are in the area affected by Sandy, there are many local shelters and organizations that could use assistance. If you are outside the area and would like to help, consider a donation to the Red Cross or other reputable charitable organizations assisting in the recovery.

Allow yourself to enjoy the routine activities of day to day life. Large scale tragedies often provide ironic moments of calm in our normally hassled daily lives. Turn off the radio and TV and take some time to sit with family, friends, and neighbors and enjoy a simple meal or play a board game. These moments can also aid in processing the events and allow us to reconnect with others.

Do not hesitate to ask for help. As the weeks and months pass some may discover they are more agitated than usual, having difficulty sleeping, experiencing unexpected panic, or just feeling down and depressed. These could be symptoms of post-traumatic stress and you should not hesitate to visit your doctor or a mental health professional for help. We all process trauma differently and there is no shame in seeking help, no matter what you experienced during this or other traumatic events.

--Andrew Schwartz, Ph.D.

0 New 401(k) and IRA limits could make saving a little easier

The IRS's recent announcement of new, higher limits on 401(k) and IRA contributions didn't make a lot of headlines. And no wonder, given that it was competing against both the presidential race and a looming hurricane.

Still, for those of us who are scrambling to save enough money for retirement, it's news we can use. So, in case you missed it, a quick recap:

• For 401(k) contributions, the new annual limit for 2013 is $17,500 for anyone under 50. That's up from $17,000 this past year. The additional catch-up contribution for people 50 and older remains at $5,500. So the combined limit for that latter group is now $23,000.
• For IRAs, the limit has increased to $5,500 for under-50s, up from $5,000 in 2012. The catch-up contribution remains unchanged, at $1,000.

Those are the changes that will probably affect the most people. But many other retirement-plan limits changed as well. They're summarized by the IRS in this handy table.

Related:
Avoid costly retirement mistakes
7 rules to retire by
Reinventing yourself in retirement

0 Consumer Reports poll: Election outcome will impact holiday mood and spending

With the presidential election looming and millions of Americans trying to piece their lives back together following the devastation of Hurricane Sandy, it's easy to understand why many consumers haven't begun to think seriously about the upcoming winter holidays. But the clock is ticking; Black Friday is just three weeks off. And in the first of our series of annual holiday polls, it appears as if the outcome of Tuesday's election could play a significant role in peoples' outlook and willingness to dig into their wallets.

One-third of American adults surveyed between Oct. 25 and 28 expect to be more cheerful this holiday season than last year. That's the good news. But that joy and optimism could fade quickly depending on the results of the race for president. Hence, the bad news: Thirty-one percent expect this season to be glum if the candidate they support loses. Moreover, 31 percent of respondents expect the election outcome to have at least some effect on their holiday spending; 17 percent indicated that the results will have "a lot" of impact on how much they spend.

Our survey, a nationally representative telephone poll of 1,013 adults age 18 and over, reveals a cautious population still licking its wounds from years of economic woes. Around 30 percent of gift givers said they plan to spend less this season vs. 2011. Only 20 percent intend to increase spending (though that figure is up 5 percentage points from who said so at this time last year).

Whether people spend more or less this year won't hinge as much on who wins the race for the nation's chief executive, but rather by consumers' perception of the state of the economy and gasoline prices - the two most influential factors, according to our survey. Indeed, half of respondents cited gas prices and the economy as the variables most likely to affect spending; 36 percent cited concern about job security.

Nearly 193 million adults plan to participate in the holiday shopping frenzy this year. In 2011, the median amount spend was $514.

Tod Marks