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d. Respectful and helpful healthcare staff who <br />communicate well in my language <br />Yes <br />No <br />Not <br />Sure <br />a. Insurance through a current or former employer of you or your spouse <br />e. Affordable in-home care with well-trained workers <br />b. Insurance purchased directly from an insurance company <br />f. Mental and physical health and wellness programs <br />including exercise facilities and classes <br />d. Medicaid or any kind of government assistance plan for those with low <br />incomes or a disability <br />g. Public health services <br />e Medicaid or any kind of government assistance plan for those with low <br />incomes or a disability <br />h. Affordable or no -cost food delivery service <br />g Other, specify: <br />i. A service that helps seniors find and access health <br />and supportive services <br />20. Are there deficiencies in item 19 (Health & Wellness) that are particularly important to <br />you? <br />21. Do you have any of the following kinds of health care coverage? CHECK ALL THAT <br />APPLY. <br />22. IF YOU ANSWERED MEDICARE above, Please mark which Medicare plan you have: (All <br />others, please skip to #23.) <br />a. Medicare Advantage Plan <br />b. Original Medicare <br />c. Supplemental Medicare Insurance <br />SOCIAL PARTICIPATION, INCLUSION AND EDUCATIONAL OPPORTUNITIES <br />103 <br />Yes <br />No <br />Not <br />Sure <br />a. Insurance through a current or former employer of you or your spouse <br />b. Insurance purchased directly from an insurance company <br />C. Medicare (for people 65 or older or certain people with certain health <br />disabilities) <br />d. Medicaid or any kind of government assistance plan for those with low <br />incomes or a disability <br />e Medicaid or any kind of government assistance plan for those with low <br />incomes or a disability <br />f Any other insurance coverage <br />g Other, specify: <br />22. IF YOU ANSWERED MEDICARE above, Please mark which Medicare plan you have: (All <br />others, please skip to #23.) <br />a. Medicare Advantage Plan <br />b. Original Medicare <br />c. Supplemental Medicare Insurance <br />SOCIAL PARTICIPATION, INCLUSION AND EDUCATIONAL OPPORTUNITIES <br />103 <br />