Q: I hate to admit it, but at the beginning of every year I get confused about the Medicare Part B deductible. I see several doctors and never know which one I should pay. I know there must be a simple explanation. Can you help?

A: Your problem is not unique. There are many seniors who face this same dilemma each year. However, you are right: There is a simple explanation. The key to the puzzle can be found in your Medicare Summary Notice (MSN).

The Medicare Part B deductible for 2008 will be $135 and it is applied on a first claim received, first claim applied to the deductible basis. This means that when the New Year begins Medicare will apply your deductible amount to the first claim or claims received until the full $135 deductible has been satisfied.

The first claim may or may not necessarily be for the first doctor visit you make in the new year.

Your MSN will show you to which provider's services Medicare applied the deductible amount, the amount of the deductible owed to a particular provider and how much of your deductible has been met for the year. You should then receive a bill from that provider for the amount owed.

Once you have satisfied the full $135 deductible, subsequent MSNs will state that your deductible has been met for the year and Medicare will begin to pay their portion of the claims.

Your provider does have the option of requesting the deductible amount at the time of your visit, however, since your deductible status may not be known at that time.

I suggest that you wait until you receive your MSN before making any payment.

Q: In previous columns you have written about the importance of communication between caregivers and the one who is being cared for. With the care of an Alzheimer patient this seems to be, at times, almost impossible. Do you have any suggestions for the type of situation?

A: Communicating with a person who has any form of dementia can be difficult. To obtain information about dealing with people with dementia I contacted the Alzheimer's Association, and representatives were kind enough to provide me with some suggestions for better communication methods with those with memory loss.

When patients have problems making their needs or wants understood don't try to rush them. Be patient and supportive. Make sure the patient knows that you are listening and trying to understand what they are trying to communicate.

Keep eye contact and show interest in their request or statement. Encourage them to continue to explain and give them time to think about what they are trying to say. Be sure not to interrupt.

If the person is saying something you don't agree with, just let it go — arguing often only makes the situation more stressful for both parties.

Avoid criticizing or correcting; instead listen and try to understand the meaning of what is being said.

If the person can't find the right word or uses the wrong word offer a guess at what is being said or requested. But be careful not to frustrate the person in the process.

Many times emotions are involved in what is being said. Usually emotions are more important that the words themselves. Look for the feelings behind the words. This may aid in what is being requested or stated.

Whenever possible, try to communicate in a quiet place where distractions are limited. This allows the person to focus on what he or she is attempting to communicate.

Sometimes when verbal communication isn't working nonverbal gestures can get the message across. Ask the person to point or indicate in nonverbal gestures.

Communication can, at times, be difficult, but with patience and understanding it can be accomplished.

Hope that these suggestions will help.

Medicare Part D enrollment

One-stop-shops will take place from 8 a.m. to 4 p.m. at the Area Agency on Aging, 646 County Square Drive, Ventura, on the following days: today, Wednesday and Dec. 27.

— Betty Berry is a senior advocate for Senior Concerns. The advocates are at the Goebel Senior Adult Center, 1385 E. Janss Road, Thousand Oaks, CA 91362; or call 495-6250. You are invited to submit questions on senior issues.