Mutual of Omaha Rx Plus (PDP)

Health Insurance Company: Mutual of Omaha Rx

Medicare Prescription Drug Part D Plan Details

Mutual of Omaha Rx
$112 /mo
monthly premium
Mutual of Omaha Rx Plus (PDP)
Coverage
Overall Star Rating (2024)
  • Rx
1.5
out of 5 stars

General Plan Details

Prescription Drug Deductible
$545
Preferred Generic copay
$8
Preferred Brand copay
$0
Eligible for Low Income Subsidy
No

Rx Drug Coverage - Preferred Retail Cost

Tier 1: Preferred Generic

$1.00 copay (30-day supply)
$3.00 copay (90-day supply)

Tier 2: Generic

$5.00 copay (30-day supply)
$15.00 copay (90-day supply)

Tier 3: Preferred Brand

17% coinsurance (30-day supply)
17% coinsurance (90-day supply)

Tier 4: Non-Preferred Drug

39% coinsurance (30-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

$8.00 copay (30-day supply)
$24.00 copay (90-day supply)

Tier 2: Generic

$12.00 copay (30-day supply)
$36.00 copay (90-day supply)

Tier 3: Preferred Brand

19% coinsurance (30-day supply)
19% coinsurance (90-day supply)

Tier 4: Non-Preferred Drug

41% coinsurance (30-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Rx Drug Coverage - Standard Mail Order Cost

Tier 1: Preferred Generic

$2.50 copay (90-day supply)

Tier 2: Generic

$12.50 copay (90-day supply)

Tier 3: Preferred Brand

17% coinsurance (90-day supply)

Tier 4: Non-Preferred Drug

41% coinsurance (30-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Rx Drug Coverage - Preferred Mail Order Cost

Tier 1: Preferred Generic

$2.50 copay (90-day supply)

Tier 2: Generic

$12.50 copay (90-day supply)

Tier 3: Preferred Brand

17% coinsurance (90-day supply)

Tier 4: Non-Preferred Drug

39% coinsurance (30-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Plan Links

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Where This Plan is Available

Additional Plan Info

Year:
2024
Plan ID:
S7126-031-0
Insurance Company Website:
Mutual of Omaha Rx

Health Insurance Companies Offering Plans

Medicare Advantage and Part D plans and benefits offered by the following carriers:

  • Aetna Medicare
  • Anthem Blue Cross Blue Shield
  • Aspire Health Plan
  • Dean Health Plan
  • Devoted Health
  • GlobalHealth
  • Health Care Service Corporation
  • Cigna Healthcare
  • Humana
  • Medica Central Health Plan
  • Molina Healthcare
  • Mutual of Omaha
  • Premera Blue Cross
  • SCAN Health Plan
  • Scott and White Health Plan now part of Baylor Scott & White Health
  • UnitedHealthcareⓇ
  • Wellcare