Mutual of Omaha Rx Essential (PDP)
(2 / 5)
Mutual of Omaha Rx Essential (PDP) is a Medicare Prescription Drug Plan by Mutual of Omaha Rx.
This page features plan details for 2024 Mutual of Omaha Rx Essential (PDP) S7126 – 129 – 0.
Locations
Mutual of Omaha Rx Essential (PDP) is offered in the following locations.
Plan Overview
Mutual of Omaha Rx Essential (PDP) offers the following coverage and cost-sharing.
| Insurer: | Mutual of Omaha Rx |
| Drugs Covered: | Yes |
- This plan does not charge an annual deductible for all drugs. The $505 annual deductible only applies to drugs on certain tiers.
Ready to sign up for Mutual of Omaha Rx Essential (PDP) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Premium Breakdown
Mutual of Omaha Rx Essential (PDP) has a monthly premium of $22.80. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $0.00 | $ | $22.80 | $0.00 | $ |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
- You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.
Drug Info
Mutual of Omaha Rx Essential (PDP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $545.00 |
| Initial Coverage Limit: | $5,030.00 |
| Catastrophic Coverage Limit: | $8,000.00 |
| Drug Benefit Type: | Enhanced |
| Additional Gap Coverage: | No |
| Formulary Link: | Formulary Link |
Part D Premium Reduction
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
| Part D | LIS Full |
|---|---|
| $22.80 | $22.80 |
Initial Coverage Phase
After you pay your $545.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $15.00 copay | ||
| 2 (Generic) | $15.00 copay | $20.00 copay | ||
| 3 (Preferred Brand) | 20% | 22% | ||
| 4 (Non-Preferred Drug) | 48% | 50% | 48% | 50% |
| 5 (Specialty Tier) | 25% | 25% | 25% | 25% |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | ||||
| 2 (Generic) | ||||
| 3 (Preferred Brand) | ||||
| 4 (Non-Preferred Drug) | ||||
| 5 (Specialty Tier) |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $45.00 copay | $0.00 copay | $0.00 copay |
| 2 (Generic) | $45.00 copay | $60.00 copay | $37.50 copay | $37.50 copay |
| 3 (Preferred Brand) | 20% | 22% | 20% | 20% |
| 4 (Non-Preferred Drug) | ||||
| 5 (Specialty Tier) |
Gap Coverage Phase
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced benefit type.
Ready to sign up for Mutual of Omaha Rx Essential (PDP) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST