2024 Medicare Prescription Drug Plan Details | |||||
---|---|---|---|---|---|
Medicare Plan Name: | Mutual of Omaha Rx Essential (PDP) by Mutual of Omaha Rx | ||||
State: | North Carolina | ||||
Plan ID: | S7126 - 110 - 0 Click to see other plans | ||||
Member Services: | 1-855-864-6797 TTY users 1-800-716-3231 | ||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
Medicare Contact Information: | Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance |
||||
Email a copy of the Mutual of Omaha Rx Essential (PDP) benefit details | |||||
— Medicare Plan Features — | |||||
Monthly Premium: | $24.90 (see Plan Premium Details below) | ||||
Annual Deductible: | $545 (Tier 1 excluded from the Deductible.) | ||||
$0 Premium if LIS Benefits? | No, this plan does NOT qualify for the $0 Premium. (See premium for LIS subsidy beneficiaries below.) | ||||
Annual Initial Coverage Limit (ICL): | $5,030 | ||||
Drug Benefit Type ❔ | Enhanced Alternative (EA) | ||||
Additional Gap Coverage? | No additional gap coverage, only the Donut Hole Discount | ||||
Total Number of Formulary Drugs: | 3,222 drugs | Browse the Mutual of Omaha Rx Essential (PDP) Formulary | |||
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers. | |||||
Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less. | |||||
Formulary Drug Details: | Tier 1 | Tier 2 | Tier 3 | Tier 4 | Tier 5 |
• Preferred Pharmacy Cost-Sharing during initial coverage phase: | $0.00 | $15.00 | 20% | 48% | 25% |
• Number of Drugs per Tier: | 289 | 649 | 714 | 998 | 572 |
Plan Offers Mail Order? | Yes | ||||
Medicare Plan Pharmacy Numbers: | BIN: 610014 PCN: MEDDPRIME See BIN/PCNs for all plans | ||||
Plan Type (Reach): | National Plan | ||||
Number of Members enrolled in this plan in North Carolina: | 3,920 members (CMS Region 08) | ||||
Number of Members enrolled in this plan nationally: | 97,524 members | ||||
Plan’s Summary Star Rating: | 1.5 out of 5 Stars. | ||||
• Customer Service Rating: | 2 out of 5 Stars. | ||||
• Member Experience Rating: | 1 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 3 out of 5 Stars. | ||||
— Plan Premium Details — | |||||
The Monthly Premium is Split as Follows: ❔ | Total Premium | Part D Basic Premium | Part D Supplemental Premium | ||
$24.90 | $-3.40 | $28.30 | |||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | $24.90 |