Mutual of Omaha Rx Plus (PDP)
S7126 - 005
(3.5 / 5)
Mutual of Omaha Rx Plus (PDP) is a Medicare Part D Prescription Drug Plan by Mutual of Omaha Rx.
This page features plan details for 2022 Mutual of Omaha Rx Plus (PDP) S7126 – 005.
IMPORTANT: You are viewing the 2022 version of this plan. See the 2023 version of Mutual of Omaha Rx Plus (PDP)
S7126 - 005.
Locations
Mutual of Omaha Rx Plus (PDP) is offered in the following locations.
Plan Overview
Mutual of Omaha Rx Plus (PDP) offers the following coverage and cost-sharing.
| Insurer: | Mutual of Omaha Rx |
| Drugs Covered: | Yes |
Ready to sign up for Mutual of Omaha Rx Plus (PDP) ?
Get help from a licensed insurance agent.
Click to Call 1-877-354-4611 TTY 711.
Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.
Drug Info
Mutual of Omaha Rx Plus (PDP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $480.00 |
| Initial Coverage Limit: | $4430 |
| Catastrophic Coverage Limit: | $7050 |
| Drug Benefit Type: | Basic |
| 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 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $80.30 | $70.10 | $59.90 | $49.70 | $39.60 |
Initial Coverage Phase
After you pay your $480.00 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 $4430. Once you reach that amount, you will enter the next coverage phase.
30 Day
60 Day
90 Day
30 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $1.00 copay | $8.00 copay | ||
| 2 (Generic) | $3.00 copay | $10.00 copay | ||
| 3 (Preferred Brand) | 18% | 20% | ||
| 4 (Non-Preferred Drug) | 47% | 49% | 47% | 47% |
| 5 (Specialty Tier) | 25% | 25% | 25% | 25% |
60 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | ||||
| 2 (Generic) | ||||
| 3 (Preferred Brand) | ||||
| 4 (Non-Preferred Drug) | ||||
| 5 (Specialty Tier) |
90 Day
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $3.00 copay | $24.00 copay | $3.00 copay | $3.00 copay |
| 2 (Generic) | $9.00 copay | $30.00 copay | $9.00 copay | $9.00 copay |
| 3 (Preferred Brand) | 18% | 20% | 18% | 18% |
| 4 (Non-Preferred Drug) | ||||
| 5 (Specialty Tier) |
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $4430, you will pay no more than the amounts below for any drug tier until you reach $7050.
30 Day
90 Day
30 Day
90 Day
| 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 $7050, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
| Drug Type | Cost Share |
|---|---|
| Generic drugs | $3.95 copay or 5% (whichever costs more) |
| Brand-name drugs | $9.85 copay or 5% (whichever costs more) |
Ready to sign up for Mutual of Omaha Rx Plus (PDP) ?
Get help from a licensed insurance agent.
Click to Call 1-877-354-4611 TTY 711.
Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.