Mutual of Omaha Rx Plus (PDP)
Health Insurance Company: Mutual of Omaha Rx
Medicare Prescription Drug Part D Plan Details
- Rx
General Plan Details
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
Ready to Enroll Online?
Or call and get free advice from licensed insurance agents