 Welcome everybody. Thank you for joining. My name is Amna and I'm a librarian at the Business Science and Technology Center of the Maine Library. I'm your host for this program along with my colleague Leah. The topic of today's presentation is Medicare Overview. Maria the Lordess Richardson is our presenter. Closed captions are available. You can enable closed caption by selecting it from your Zoom toolbar. We will be recording today's session and shortly after the program I will email the link with the recording and I will also send out the slide deck shared by our presenter and an evaluation survey. I'll start off by sharing our land acknowledgement. Our library acknowledges that we occupy the unseeded ancestral homeland of the Ramatush Aloni people who are the original inhabitants of San Francisco Peninsula. We recognize that we benefit from living and working on their traditional homeland. As uninvited guests, we affirm their sovereign rights as first people and we wish to pay our respect to the ancestors and elders of the Ramatush community. I'll just move through my slides. I'm sorry to be not at the beginning but here is the information about how to get closed captions and you can always visit us on the fourth floor of the Maine Library. We are the Business Science and Technology Center located at 100 Larkin Street in the Maine Library. You can also email us if you have questions at bizcitech at sfpl.org. Our library's programs are often recorded and our department's programs can be found if they're recorded at the YouTube page of the SFPL library and our topic is Work It, under which you can find as a playlist most of our recordings. To find out about upcoming library programs you can come to the library homepage and select the events and exhibits button. Health and wellness programs can be searched for by using that as the topic and a lot of our department's programs can also be found under the Work It topic. Some upcoming Work It programs have to do with jobs and careers, personal finance and small business and we welcome you to register for all these upcoming programs. I will now stop my share and turn it over to our presenter, Maria de Lorde de Richardson. Maria is the Latino Services Coordinator with the Independent Living Resource Center. She's also certified by the Health Insurance Counseling and Advocacy Program. I'd like to pass it over to Maria. Maria, you may begin. Thank you. Good afternoon. My name is Maria de Lorde de Richardson. I am the Latino Community Service Coordinator. I work at Independent Living Resource Center and I am ICAP certified. ICAP stands for Health Insurance Counseling and Advocacy Program. Today we will be talking about Medicare. We'll have an overview and your options. Welcome to Medicare. We'll be discussing the principles of Medicare, the parts that consist with Medicare. We'll go into a little bit about Medicare. We'll talk about MediCal. We'll also discuss ways to supplement Medicare and how to use the plan finder. What is Medicare? It is a national federal health insurance program designed through private health insurance that covers part of the cost of some health services. It was started in 1965, initially available to people 65 and over, consisting of part A and part B. Then it expanded over time. Medicare related bills are paid from two trust funds held by the U.S. Treasury, payroll taxes and funds that Congress authorizes. People with Medicare pay part of the cost through things like monthly premiums for MediCal, for medical and drug coverage, deductibles, and coinsurance. Who is eligible? Individuals 65 years of age or older entitled to Social Security or Railroad retirement benefits. A lawful permanent resident who has lived in the United States at least five years. People who are under the age of 65 who have received Social Security disability insurance for 24 months. That's two years on the 25th month they will be offered their Medicare. That's when it will start. And people of all ages with end-stage renal disease or amyotrophic lateral sclerosis may be eligible. There's different time periods to enroll. So I'm going to be using my notes because some of the information is covered. And so when rolling Medicare, you would go to the Social Security Administration office. That's where the enrollment starts. There are different periods throughout periods of which you can enroll. The initial enrollment period is a seven month period time. It begins three months before the month of your birthday, the month of your birthday, and three months after you turn 65. The general registration period is from January 1st to March 31st. This would pertain to somebody who did not enroll in Medicare during the initial enrollment period. They could enroll during this time and they may have a penalty depending on their circumstance. At the moment, we are in open enrollment period, which lasts from October 15th to December 7th. It is seven weeks and during this time you can decide to keep what you have or decide to change it. It all depends on how you want to receive your Medicare. Now, there's also something new. It's called Medicare Advantage Open Enrollment Period. This is from January 1st to March 31st. During this period, you can decide to change to another Medicare Advantage plan or switch back to original Medicare. Usually this would pertain to somebody who during the open enrollment period enrolls in a Medicare Advantage plan and it started in January and they were not happy with it. So they have three months to decide if they want to change it back to original Medicare or to another Medicare Advantage plan. Special enrollment period refers to a life-changing event, meaning you moved or you lost employer group coverage. So this is what is referred to a special enrollment period. We also have a five-star special registration period, which lasts from December 8th to November 30th of the following year. Now, this is in reference to plans that have a five-star. At the moment, the only plan that we have that has a five-star is Kaiser. So if you are not happy with what you have, you can decide to change into Kaiser, which has five stars during any month within the time period of December 8th to November 30th. No, if you are receiving benefits from the Social Security Administration, they will automatically send your Medicare card when you are eligible. Once you have Medicare, then the Center of Medicare and Medicaid Services, CMS, administers Medicare. Your options on how you will receive your benefits. So Medicare, original, some people call it a traditional Medicare or Medicare Advantage. So I have put a chart here and it has two sides. One, it has Medicare original, which consists of part A, hospital, part B, medical. That is what you see on your Medicare card. If you decide to keep Medicare original, you just add a prescription drug plan to your coverage. And my apologies, it says part B because I was translating it from a Spanish presentation I did. Part D is prescription drug coverage. Now it is optional if you would like to add supplemental coverage to Medicare, which is called Medigap. A Medigap is an insurance policy that can help you with the cost of some services. Now this is one option of receiving your Medicare. The other option is a Medicare Advantage. HMO, PPO, S&P. A Medicare Advantage is part C. It is a combination of part A and part B. Most Medicare Advantage plans cover prescription drugs. Note, if you enroll in a Medicare Advantage plan, you cannot be sold a supplemental coverage Medigap policy. Medicare Part A helps pay inpatient care, laboratory tests when you are hospitalized, surgeries, care in a skilled nursing facility, home health care, and hospice care, along with other things I have not mentioned. But part A usually refers ends when you're in the hospital. Medicare Part B helps pay medical services and other health care providers, diagnostic tests and x-rays, some home health care such as physical and occupational therapy, durable medical equipment, limited ambulance services, preventive services such as exams, immunizations, and annual wellness visits. Part B refers to medical when you're in and out. So when you're going to the hospital, and coming back home, you are using Part B. Original Medicare cost. Part A hospital, there is a deductible to Part A hospitalization, and that deductible amount for 2024 will be 1632. Part B deductible, the deductible for 2024 will be $240. 20% coinsurance for most Part B services, Medicare pays 80%, and you will pay 20%. Hospital and skilled nursing facility daily co-payments and the monthly Part B premium for next year will be $174.70. There is no limit on out-of-pocket costs, and you have the decision if you would like to add a Medicare policy to your coverage. Medicare Part D, the Medicare Modernization Improvement and Prescription Drug Act of 2003 added a new prescription drug program to Medicare. It was created on January 1, 2006 to provide beneficiaries with certain prescription drug coverage. Landsat offer Medicare Part D drug coverage are administered by private insurance companies that follow the rules set by Medicare. Part D helps with drug costs, including many of the recommended vaccines. Anyone with Medicare is eligible for Medicare Part D. If you are eligible but do not enroll or do not have credible coverage, you could face a premium penalty in the future. What does Part D cover? Outpatient prescription drugs. Drugs covered under Part D plans formulary. A formulary is a list of drugs covered by the plan. You can change plans every year or quarterly if you have extra help. Most vaccines and shots such as shingles vaccine is covered. Vaccines to prevent the flu, pneumonia, and hepatitis B. And vaccines, one gets if you are exposed to a dangerous virus or disease such as rabies. Part D does not cover drugs that must be administered by a health care professional. If you go to a clinic and a health care administers these drugs to you, they are usually covered under Part B. Part B also covers drugs needed for the use with durable medical equipment. That might be if someone has diabetes. So Part B might cover some of the medications if they're using durable medical equipment when administering the medication. Now the cost for Medicare drug coverage. Throughout the year, you'll make these payments if you are in a drug plan. You will pay the premium, yearly deductible, co-payments or the coinsurance, the cost in the coverage gap, and you'll pay some costs if you get extra help. Costs if you pay a late enrollment penalty. So these fees will be applied to you if you are in a drug coverage plan. Your actual drug coverage costs will vary depending on your prescriptions and whether they're on your plans list of covered drugs, the formulary. The medications are placed on a tier. The lower the tier, the least the cost, the higher the tier, the more it costs. An example of tier one would be a generic drug. An example of tier two would be a non-preferred generic drug. An example of tier three would be a brand name. And an example of tier four would be a non-preferred brand name. Which drug benefit phase you're in, like whether you meet your deductible or if you're in the catastrophe coverage phase. So based on whatever phase you're in, that's how the cost will be applied to you. And the pharmacy you use. Whether it offers preferred or standard cost sharing. Is out of a network or is mail ordered? Your out-of-pocket drug costs may be less at a preferred pharmacy because it has agreed with your plan to charge less. Whether you get extra help paying your Medicare drug coverage cost. Okay, I'm sorry. We're going to talk about Medigap supplement insurance. Medigap is insurance sold by private insurance companies to cover gaps in the original Medicare coverage. It complements Medicare and can help you pay for what original Medicare doesn't cover, such as co-pays, coinsurance and deductible. A Medigap must comply with federal and state laws enacted to protect you and must clearly state that it is a Medicare supplement insurance. Some Medigap plans cover medical care when you're traveling outside the United States. Typically, a Medigap does not cover long term care, such as nursing home, vision, dental care, hearing aids, eyeglasses or a private nurse. All plans must offer the same basic coverage and some offer additional benefits for you to choose the one that suits you best. What else should you know about a Medigap? You must have Medicare Part A and Part B before you can buy a Medigap. You will have to pay the monthly premium to the private company of the Medigap plan in addition to paying the monthly premium for Medicare Part B. Medigap plans only cover one person. The best time to buy a Medigap is during the open enrollment period. I believe it begins six months. On the first day of the month, you turn 65 or older and you are enrolled in Part B. I'm just making sure I have the correct information. Yes, six months. It begins the first day of the month. You turn 65 or older and you are enrolled in Part B. Your options for buying a Medigap may be limited and may cost you more after the initial enrollment period. Federal law does not require insurance companies to sell a Medigap to a beneficiary who is under the age of 65. Now on this slide, you will see the Medigap plans. They range from a letter A to to N. And if you see the first line, it says hospital copayment. All Medigaps need to cover hospital copayments. And when you go down the line, you see that let's say for instant Medigap policy A, it only covers hospital copayment. It helps with Part B coinsurance with the first three pints of blood. And then we go down to 100% of coinsurance for Part B covered preventive care services and cost-disccare. So policy A only covers those items. And if you go down to the next line, you will see what B covers. There is a policy C and F are no longer sold. They stop being sold after January 2020. So Part B annual deductibles, those two plans stop being sold. But if you had them, you were grandfathered in and were able to keep them. And I believe that if you had Medicare before that time, you were able to purchase them. So they are no longer sold. And you're able, I put up more information so I will explain it in a minute. We're going to go on to speak about Medicare Advantage Plans. A Medicare health plan offered by a private company that contracts with Medicare. Medicare Part C, known as the Medicare Advantage Plan, offers all the benefits of Part A and Part B. The types of Medicare Advantage Plans are called HMOs, Health Maintenance Organization, PPO's Provider Organization, SMP, Special Needs Plan. If you are enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. Medicare services are not paid for by regional Medicare. Most Medicare Advantage Plans offer prescription drug coverage. Medicare Advantage Eligibility. To be eligible for a Medicare Advantage Plan, you must have Medicare Part A and Part B. Live in the plan's geographical service area. You may need to use providers that participate in the plan's network unless the plan offers out-of-network coverage. These plans set a limit on what you'll have to pay out-of-pocket each year for covered services. You will usually need to get approval from your plan before it covers certain drugs or services. And you must use your Medicare Advantage Plan membership card to get Medicare covered services. Please keep your Medicare card in a safe place. Types the Medicare Advantage Plans. Health Maintenance Organizations. These plans offer a network of healthcare providers. Low monthly premiums providers have a contract with a health plan. You will choose a primary care physician. This person will manage your care and refer you to specialists. Prefer provider organizations. Offering network of providers as well as the option to consult providers who are not part of this network for a higher cost. You do not need a primary care physician to manage your care. Premiums will be higher in this plan, but you will have more freedom. Medicare Advantage Special Needs Plans. You must have Medicare and be eligible for MediCal to be a member. Dual Special Needs Plans, G, SNPs, are for people who have both Medicare and MediCal. Chronic Special Needs Plans are for people with severe or disabling long-term health problems. These dual health plans offer additional benefits such as dental, vision, hearing, and much more. These plans have no monthly premium. You will also qualify for extra health pain for your medications. MediCal and Medicare. I'm sorry. MediCal is California's healthcare program. Medicaid and MediCal are the same thing. California likes to be unique and rename the program. Your MediCal card may be white with blue writing and has an image of the seal of the state of California with your name, identification number, and other information belonging to you. Or you may have the new color card that has California flowers. No matter which one you have, the two work the same. The program pays for a variety of medical services for children and adults with limited income and resources. MediCal is backed by federal and state taxes. MediCal covers physician services, hospital care, laboratory services, maternity and newborn care, behavioral health services, prescription drugs, dental services, rehabilitation services and therapies, prosthetic devices, eye exams, and glasses, personal care, and emergency services. Original Medicare and MediCal. Medicare enrollment is usually done during a specific period or event while MediCal enrollment is open year round. It is important to note that specific details about eligibility and coverage may vary depending on the state and individual situation. It is recommended to contact relevant government agencies or seek professional advice for accurate information about these programs. In San Francisco County, there are two plans that offer that are offered to receive your MediCal, which are called managed care. They both are San Francisco Health Plan and Anthem Blue Cross. Medicare and MediCal coordination. Dual eligible, an individual who is enrolled in both Medicare and MediCal. Full dual eligibility is an individual enrolled in Part A and or Part B and MediCal. Partial dual eligibility is an individual with a Medicare savings program. Medicare and MediCal work together to cover individuals health care needs. Medicare pays first, MediCal pays second. Medicaid and MediCal, which is the same thing, is payer of last resort. If an individual has a retiree insurance as well, Medicare pays first, retiree insurance pays second, and MediCal pays last. Full dual eligible individual usually do not have to pay Part A and Part B premiums, deductibles, co-insurance, or co-pays. MediCal can cover services that Medicare does not, such as dental, vision, and also depends on the state and where you live. Dual eligibility individuals should see providers who accept both Medicare and MediCal to receive the best coverage with lowest out-of-pocket cost. There's three Medicare savings programs, which are administered by the MediCal office, which is the Human Service Agency, and they are available for people with limited incomes. The three levels of Medicare savings programs are called Quimby, Slimby, and QI. Quimby is qualified Medicare beneficiary, Slimby is best-buy low-income Medicare beneficiary, and QI is qualified individual. All three levels help pay the monthly Part B premiums. In all three levels, one is automatically eligible for low-income subsidy, LIS, or extra help for prescriptions. QMB helps with deductibles and co-insurance for services from a participating Medicare and MediCal provider. To be eligible for the Slimby, one must have Part A and their income must be between 100% and 120% of the federal poverty level to be eligible for this program. To qualify for the qualified individual program, one must have income between 120% and 130% of the federal poverty level to be eligible for this program. Extra help program, also known as Medicare Part D low-income subsidy. It is a federal program administered through private insurance companies. You are automatically enrolled in a Part D plan with extra help if you qualify for MediCal or are enrolled in a Medicare savings program. If you do not automatically qualify, you can apply for extra help through the Social Security Administration or by completing the online application. The program helps you pay a portion of Part D prescription drug plan costs such as Part D premiums, deductibles, and co-payments. Your income is a factor that determines whether you qualify for total or partial subsidy. Types of extra help, full and partial extra help. Full extra help, it has lower income limits than partial extra help. Both full and partial extra help enrollment beneficiaries in a Part D eliminate premium penalties and allow beneficiaries to change Part D coverage once per quarter for the first three quarters of the year and the last quarter they must use the open enrollment period so that their plan can begin on the first of the year. Full extra help pays Part D premium up to benchmark amount for the basic plans. Benchmark amount varies by state. Pays deductible and lowers co-pays or co-insurance for covered drugs provides full coverage during the coverage gap. For partial extra help, it helps pay some of the beneficiary Part D premium. It helps pay some of the cost of covered drugs and it helps the beneficiary pay 15% co-insurance or plan co-pay, whichever is cheaper and it provides some coverage during the coverage gap. To use the plan finder for Medicare, you can go to www.Medicare.gov and make sure you're on the official website for Medicare and select find health and drug plans. You can search doing a general search by putting in a zip code and entering medication names in the pharmacy or you can personalize your search and create a username and a password. You will enter your zip code, your Medicare number, your last name, when your part A or P were effective, the date of your birth. If you create a personalized search, you will be able to look at your page and that will help you review the medications you have taken for the year and you will be able to update your medications and review the medications, remove the medications you are no longer taking to do a better search. The plan finder will allow you to search for Part D plans, Medicare Advantage plans and will also let you look up Medicare. How should I protect my information and when should I give my Medicare number or other personal information to others? You should always protect your Medicare or Medicare number as if it was a credit card. This information is unique to you. It is recommended that you only provide your information to your healthcare providers. When you call a plate like Medicare or Medicare, they may ask you more questions and more personalized because they want to make sure they are speaking to the right person. But when you call a plan seller, especially for an ad that you've seen on TV and you provide them your personal information, you do not know who you're speaking to and you don't know what they will be doing with your information and they can sell it and they might be able to cause fraud and abuse. Please be very careful who you share your information with. If you have a Part D prescription drug plan, please let your healthcare provider know so that they are ensuring that the formulary medications they are prescribing for you is covered under that plan. And if you go to a pharmacy, also allow them to see your card if they do not have that information already. If you suspect fraud or abuse, please reach out to the Senior Medical Patrol so that they can investigate it. These are useful resources. I put some. I hope that they can help you and this is the end of my presentation. I hope that I have provided you some useful information and I will stop sharing my screen. Maria, there are a few questions that I can read out to you. If you would like or the first one is what is the benchmark amount for California State or how to find the benchmark amount by state? I believe they just put it out for next year and the benchmark amount is about $40. And so for us in San Francisco, I know that there are only three benchmark plans. This year we had four. Next year we have three. They are removing silverscript so we will have well-care, signal, and clear springs. If you qualify for extra help and those plans do not cover your medications and you select a plan that has a premium and they will deduct that $40 from that premium and you will pay whatever is left over and then you will get to pay the extra help amount, which I believe next year will be $1.55 for generic and $4.65 for branding, something like that. The next question is, I thought underwriting required to switch back from Medicare advantage to regular Medicare. Excuse me, can you repeat that question? Yes, sure. So it says I thought that underwriting required to switch back from Medicare advantage to regular Medicare. I don't know if they have any such thing as underwriting. But if you're eligible for Medicare, during the open enrollment, if you would like to switch your plan, you can switch. If you have extra help, you can switch every quarter. Thank you. Yeah, and I believe the Medicare advantage, if you select a Medicare advantage during the open enrollment and you want to switch, you would use the annual open enrollment from Medicare, which is January 1st through March 31st. Next question. When I read New York Times or Wall Street Journal, online articles, comments about Medicare that warn about quote unquote bad advantage plans and TV commercials. Does it mean some states have bad advantage plans that cause such blanket statements about all advantage plans? Reader comments seem to reinforce that. And some commentators praise Kaiser advantage in various states. Okay, so I think everybody has an opinion. And just to be maybe a lot of people go by stars. So if you go to Medicare.gov, you'll be able to look at the star ratings for the plans. And hopefully that will help you make a better decision. Because a lot of people have different comments on different plans. And someone may be very in favor of Kaiser, but I can have somebody who is not in favor of Kaiser. And that's perfectly fine, because that's the choice. But I think that it would be best if you have Medicare that you actually just go in the planfinder and do your research. You did receive a Medicare in you 2024 guide. It was sent out in the fall that has a lot of information. And I believe the best place for you to get Medicare information would be from Medicare itself. Because we have a lot of, I've already seen a lot of advertisements and things like that and everything you see on TV. You're actually, if you do call somebody, you're speaking to an agent. And they're just an agent which they really don't have too much information on Medicare. I hope that answers your question. Next question is this isn't exactly a Medicare question. But can we buy long term care insurance in California or are these policies on hold due to pending legislation? I believe they're still available. Is it possible for you to please reach out to a ship or high cap and ask them that question? But I believe they're still around. Next question is Kaiser offers all plans for A, B and D, including Advantage Plus. Will I be able to get extra outside medical plans? Okay, so we're going to talk about Kaiser. Kaiser is actually Part C. It's a Medicare Advantage. You are letting them administer your Part A and B, and it includes medications. So if you have a Medicare Advantage, you have a Part C. And if you join Kaiser, they are an HMO. An HMO means that they administer your overall care. They're a network. You have a doctor and it is the doctor's responsibility to refer you to the specialist. If we have additional questions, do we call SSA slash Medicare and or the high cap office? I've spoken to high cap often and they are very helpful. If you have additional questions, I would call high cap. Can you share the deductible amounts again? It was shared quickly, verbally, it was not on this slide. So I have for the deductible for hospital will be $1,632 and for the monthly premium for Part B, it would be $174.70 and the deductible for Part B will be $240. We have a lot of HMO plans and PPO plans and we have HMO dual SNP plans and we have HMO C SNP plans. And for Part D, I believe in California will have 23 plans and three of them will be benchmarked. I think there is one more question. What is the federal poverty rate? The federal poverty rate is a guideline that is placed out every year based on on how they determine incomes. It's a guide and to be more exact, I would look up what are the 2020-24 federal poverty guideline amounts for 2024. Then you'll have an exact number. The next question is, didn't Medicare premium increase for 2024? Yes. The premium was this year was $164.90. Next year it will be $174.70. And what does benchmark mean? Benchmark is a low income plan for people who receive extra help. They have different names but benchmark is low income. It's extra help. What is the income amount relative to percent for Medicare saving program? Okay. I can't answer that question but say for example, you went to apply for Medi-Cal and what would happen if you didn't qualify for Medi-Cal? What they would do is they would see if you qualify for one of the other plans based on income, your income. I think this one was answered. What is the federal poverty rate amount? Federal poverty rate amount. Yes. Okay. So let's say for example, we're talking about the Quimby. I'm just going to give you an example of what I have on my list. Say you were a single person and received a $1,215 income. You may qualify for that Quimby program. Say your income was above that and you were single. If you had $1,458, they might place you in the Slimby, specified low income Medicare beneficiary. Say your income was above that and you made $1,641, then they would place you in the qualified individual. So it's based on when you do the application and other determining factors that they have to use to consider if you qualify. Remember it's all based on whether you're single or married. So income is what determines most of the programs. Next question. What if you're not low income but high risk? And I'll try to read the rest. Can you qualify for Medicaid and or benchmark? You would have to see if you qualify. There are income limits to those programs. So if your income is high, there are some people who do not qualify for medical and only rely on Medicare. So my suggestion to you is to seek assistance from a high cap counselor so they can sit down with you and provide you individual counseling. Next question is, there are a lot of questions. I think I lost my place, but this is the one. Does Irma affect each person's part B premium price? Yes. If your income goes above a certain threshold, then the Social Security Administration will determine what you will either have to pay for part B and part D. And so they are looking at two years tax returns to determine what you will be paying. So it's income based. If you have to pay a higher premium and you have something change where your income changes, you would probably want to reach out to the Social Security Administration office and let them know so you can fill out the form and request that they change the amount you pay. Next question is, if you are with HMO, do you get medical automatically? I think you have to enroll in an HMO and you have to have part A and part B to be eligible to enroll. So remember, part A is hospitalization, part B is medical visits. So if you have A and B, you can enroll in an HMO or a PPO. Remember, the decision is yours. There are questions about chat messages, whether they'll be included and yes, they will be included in the recording also. The next question is, thank you. This has been informative. I would love to learn more as an overview and then drilling down in subsequent sessions and maybe a series, thanks again. And other people are also saying thank you and requesting a series or repeat. And then the next question is, is a retiree's SSI income, is an retiree's SSI considered income and what is considered income? Income would probably be the benefits you receive from Social Security Administration and so if an pension or any incoming income is what they consider as income. And so if you're retired, you're receiving Social Security retirement benefits, if you receive it from the Social Security Administration. So I mean, if you work enough credits and make 40 credits, which is 10 years work history, that's when you see part A on your card. It's because you worked it and you had enough credits to receive it. And so somebody that gets part A on their card, I believe worked enough to have part B and then you decide how you want to receive your Medicare. But if you have another program, maybe that's from a government or a federal employee health benefit program, there's differences. And if you get services because you're a veteran, that's different. So you really want to receive counseling before you make any decisions on what you're going to do. Because if you're receiving an employer group plan and that might be primary and you decide to change it to Medicare, you might not be able to go back. So that's why we encourage you to get counseling, especially when you're new to Medicare. Next question is SSI equals Supplemental Social Income. What is that? It's confusing. SSI is Supplemental. Okay. Sorry, I can just read the rest of it also. SSI is Supplemental Social Income. What is that? That's confusing. This is not the work benefit credit. And then in brackets says retirement. Okay. So we're going to talk about benefits a little bit. SSI is Supplemental Security Income. Now that is for people who have disabilities. Usually somebody who never worked or has little work experience would receive that. And with SSI, you automatically qualify from Medi-Cal. SSDI is Supplemental Security Disability Insurance. That is for somebody who is younger than 65 and has a disability and has enough credits to be able to get Medicare. So they have enough credits during their work history. You only have to have 40 credits. Once you have 40 credits, they stop counting. That's probably 10 years work history. And it varies for different people at certain ages. So I'm just giving you an example. And after being on SSDI for two years, they will be on Medicare on the 25th month. Medicare will be sent to you. And it's something you really can't give back. So you will have to learn how to use it. I have people who are on both a little bit of SSI and SSDI. These are considered Medi-Medi dual eligible. I hope that answers your question. The next question is what or which agency is best to get counseling and better understand benefits and process for someone who's new to Medicare systems? If you need counseling, I would recommend HICAP. You can call 415-677-7520 if you live here in San Francisco. If you do not live in San Francisco, you can call the 1-800 number, which is 1-800-434-0222 and find where your HICAP office is. Every HICAP focuses on their county. So HICAP counselors in San Francisco are geared at the services for San Francisco. And if you need HICAP in San Mateo, then you would find HICAP in San Mateo. You could also look it up and you can find on the HICAP in your county. In other places there are called SHIP counselors. Any other questions? Yes, one more question that I'm seeing is, PPO is good to have your choice, but there are lots of complaints about treatment procedure and drug costs with insurance company. Who will decide best for the patient? You will. If you're working with your family member, you will help your family member decide. HICAP counselors give information. We don't make decisions and we don't select anything for anybody. We provide the information that is provided to us to share with consumers or clients. I think we have reached the end of the questions and I don't see any more questions. So if that is all, then I would like to thank Maria so much for the wonderful presentation and useful information that was shared. Thank you to all who attended. We will send out the program recording link and slides that Maria shared along with the link to our evaluation form so you can give your feedback and suggestions and have a wonderful evening everyone. Thank you so much.