Medicare Prescription Drug Plan

This is new in 2025. In addition to the $2000 max out-of-pocket for prescription meds that are included in my Insurer's Formulary, I can elect to spread out the payments for included Meds over the entire year.
One of my wife's meds, after insurance coverage, is $2,000. So, her initial dispense covers her entire Med drug expense for the year … but the actual payments for that expense are spread out.
When attempting to set up a Loan account to represent this, I was required to:
a) just call is a Loan (calling it a Consumer loan didn't help)
b) input an initial balance greater that $0.00 (on 1/1/25, the actual balance was Zero)
c) Input a monthly payment of greater than $0.00 (actual payment won't be known until 1st bill arrives).
SO, I'm suggesting that a new Loan Type that conforms to the above parameters be created. OR, that the current loan type parameters be modified to accommodate the above.
Q user since February, 1990. DOS Version 4
Now running Quicken Windows Subscription, Business & Personal
Retired "Certified Information Systems Auditor" & Bank Audit VP
Comments
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This seems like an unusual set of parameters to set up, not like an ordinary loan. For one thing, the payments do not roll over to the next year, so if you have one large expense in December, you must pay it all at once, up to $2,000. This Fact Sheet describes the plan, with examples starting on page 6.
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@Jim_Harman Thanks for the PDF, but from it's 1st sentence "to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December)."
And that's true, this plan isn't useful for those with late in the year expenses (IIRC, the sign-up form even suggested that).
BUT, for many/most Medicare patients, our expenses occur throughout the entire year. In my wife's case, the entire $2k is in January.
BUT, since we still owe the money, that's a debt/loan that I'd like to track. And the current loan setup doesn't permit a 1/1/25 balance of $0 or a $0 known monthly payment.
I'm not suggesting that the payments be calculated (I'll let my monthly statement do that). I just want to track what's owed at any given point. And, in our case, the entire $2k is a January expense … so the monthly calc is actually pretty simple.
Q user since February, 1990. DOS Version 4
Now running Quicken Windows Subscription, Business & Personal
Retired "Certified Information Systems Auditor" & Bank Audit VP0 -
Could you set it up as a zero-interest offline credit card account?
Presumably with this plan when you receive a prescription you don't pay on the spot but you will get a receipt for the amount that will be added to the balance due, and when you make a payment it reduces the balance due, just like a credit card. The balance due must be paid off by the end of the year. When Payments + Balance due reaches $2,000, i.e. you have reached the maximum out of pocket, prescriptions for the rest of the year should be "free" and the balance due will not increase.
Thus at any given time the balance due is what you must pay by the end of the year assuming there are no additional charges.
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Well, the receipts from my pharmacy shows
"Your Insurance Benefit Saved you" and their total for the med, and
"Price" $0.00 and
Bill to: "COB", which an inquiry to the pharmacy told me was "Coordination of Benefits".BUT, by going to the Insurance website I can see the "You Owe" amount, which is presumably charged to the Pmt Plan.
I'll just have to wait until I get the first bill from the Pmt Plan to figure this all out … but since I initially started this thread I'd been thinking credit card also.
BTW, for my wife the calcs should be pretty simply … since her first order of that med hits the $2k limit. BUT, I won't hit it for 2-3 months, so the calcs for me are complicated. FORTUNATELY, I don't have to calc the amount … just pay it.
Also, some of our meds aren't covered by the Formulary … so our total OOP costs for meds will be somewhat over $2K, but not much, maybe $200 each.
Q user since February, 1990. DOS Version 4
Now running Quicken Windows Subscription, Business & Personal
Retired "Certified Information Systems Auditor" & Bank Audit VP0 -
Why not use a simple expense category? You're not getting a loan. Just stop recording transactions after the $2k limit has been reached because you won't have any that aren't $0.
Quicken user since version 2 for DOS, as of 2025 using QWin Premier (US) on Win10 Pro & Win11 Pro on 2 PCs.
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As I think more about this, it appears that the best solution depends on what questions you want to be able to answer.
If you just want to track your out of pocket expenses, you could not record the individual prescriptions at all, just the monthly payments, using an appropriate Category and tax line item. You could add a Reminder to predict the future payments.
If you want to be able to answer questions like "How much does drug X cost per year?" or "How much did illness Y cost?" an offline credit card account should work. You would have to record all the prescriptions and the insurance reimbursements, even if you have reached the out of pocket max. Your out of pocket payments would be transfers to that account.
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The amount that's been billed to the Drug plan is, to me, a debt that I/we owe. That I pay it over time, rather than all at once, is what makes it a liability of some sort.
I do track the cost of individual meds. When I pay my pharmacy, I split the transaction and record the particular med in the memo field of the split. For the ones covered by the plan, I'm thinking about recording the ACTUAL cost of the med offset by a xfer to the Drug plan "credit card". (OK, I'm a bit OCD).
And, since not all of our meds are "formulary", it's not unusual for a pharmacy payment to include both drug plan and "we pay immediately" meds.
And, once the $2k limit is reached, I still plan on recording those purchases with $0, just no longer with the offset. That way, I can track when we bought our various meds (about 12 for me and close to same for her) in Q. It's just got better search abilities than QMEM, which I also use.
Q user since February, 1990. DOS Version 4
Now running Quicken Windows Subscription, Business & Personal
Retired "Certified Information Systems Auditor" & Bank Audit VP0