2020 Medicare Prescription Drug Plan Details | |||||
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Medicare Plan Name: | Mutual of Omaha Rx Value (PDP) by Mutual of Omaha Rx | ||||
State: | Nebraska | ||||
Plan ID: | S7126 - 057 - 0 Click to see other plans | ||||
Member Services: | 1-855-864-6797 TTY users 1-800-716-3231 | ||||
— Enrollment Options — | |||||
Medicare Contact Information: | 1-800-MEDICARE (1-800-633-4227) TTY users 1-877-486-2048 |
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Advertisement ![]() Speak to a licensed sales agent to learn more and enroll. Call Medicare Solutions at 855-373-9484 / TTY 711 Monday ‐ Friday 8:30am — 10pm EST MULTIPLAN_GHHJTEXEN_ACCEPTED | |||||
Email a copy of the Mutual of Omaha Rx Value (PDP) benefit details
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— Medicare Plan Features — | |||||
Monthly Premium: | $24.50 (see Plan Premium Details below) | ||||
Annual Deductible: | $435 (Tier 1 and 2 excluded from the Deductible.) | ||||
$0 Premium if Full LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. (See premiums for partial LIS subsidy below.) | ||||
Annual Initial Coverage Limit (ICL): | $4,020 | ||||
Additional Gap Coverage? | Yes, some additional gap coverage. | ||||
Total Number of Formulary Drugs: | 2,892 drugs | Browse the Mutual of Omaha Rx Value (PDP) Formulary | |||
This plan has 5 drug tiers.
See cost-sharing for all pharmacies and tiers.
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Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $0.00 | $2.00 | $25.00 | 41% | 25% |
• Number of Drugs per Tier: | 140 | 691 | 616 | 965 | 480 |
Plan Offers Mail Order? | Yes | ||||
Plan Type (Reach): | Regional Plan | ||||
Number of Members enrolled in this plan in Nebraska: | 498 members | ||||
Number of Members enrolled in this plan in your CMS Region: | 3,159 members (CMS Region 25) | ||||
Number of Members enrolled in this plan nationally: | 36,540 members | ||||
Plan’s Summary Star Rating: | New plan - No summary rating as of yet. | ||||
• Customer Service Rating: | New plan - not yet rated. | ||||
• Member Experience Rating: | New plan - not yet rated. | ||||
• Drug Cost Accuracy Rating: | Does not apply. | ||||
— Plan Premium Details — | |||||
The Monthly Premium is Split as Follows: | Total Premium | Part D Base Premium | Part D Supplemental Premium | ||
$24.50 | $12.50 | $12.00 | |||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $12.00 | $15.10 | $18.20 | $21.40 |