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2024 Mutual of Omaha Rx Essential (PDP)

Medicare Prescription Drug Plan Benefit Details in Plain Text
The following Medicare Prescription Drug plan (PDP) benefits apply to the Mutual of Omaha Rx Essential (PDP) (S7126 - 107) in CMS Region 5, which includes all counties in DC DE MD.

This plan is administered by OMAHA HEALTH INSURANCE COMPANY, a national plan provider. This means that the insurance carrier offers Medicare Part D plan in most every state. To switch to a different Medicare Prescription Drug plan or to change your location, click here.
Click here to see the Mutual of Omaha Rx Essential (PDP) prescription drug benefit details in chart format or email and view benefits chart

Plan Premium
The Mutual of Omaha Rx Essential (PDP) has a monthly premium of $26.30. That is $315.60 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for extra help, your premium will be lower. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).

Plan Membership and Plan Ratings
The Mutual of Omaha Rx Essential (PDP) (S7126 - 107) in CMS Region 5 currently has 2,675 members, and 97,524 members in the Mutual of Omaha Rx Essential (PDP) nationwide.

The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 1.5 stars. The detail CMS plan carrier ratings are as follows:
Prescription Drug Coverage: Deductible, Cost-sharing, Formulary
This plan has a $545 deductible. However, formulary drugs on Tier 1 are excluded from the $545 deductible and have first dollar coverage (or a $0 deductible). So, you are 100% responsible for the first $545 in medication costs for drugs not on the excluded tiers. After you have met the deductible, the Mutual of Omaha Rx Essential (PDP) will share the costs of your medications with you -- see cost-sharing below. $545 is the maximum deductible for 2024. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. Click here to review plans with a $0 deductible.

The following information is about the Mutual of Omaha Rx Essential (PDP) formulary (or drug list). There are 3222 drugs on the Mutual of Omaha Rx Essential (PDP) formulary.

The Mutual of Omaha Rx Essential (PDP) does offer a mail order service.

Click here to browse the Mutual of Omaha Rx Essential (PDP) Formulary.
 
The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Once you have spent $545, your initial coverage phase will start. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Mutual of Omaha Rx Essential (PDP)’s formulary is divided into 5 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows:
  • Tier 1 (Preferred Generic) contains 289 drugs and has a co-payment of $0.00.
  • Tier 2 (Generic) contains 649 drugs and has a co-payment of $15.00.
  • Tier 3 (Preferred Brand) contains 714 drugs and has a co-insurance of 20% of the drug cost.
  • Tier 4 (Non-Preferred Drug) contains 998 drugs and has a co-insurance of 48% of the drug cost.
  • Tier 5 (Specialty Tier) contains 572 drugs and has a co-insurance of 25% of the drug cost.
    •  
All forms of insulin covered by this Medicare Part D plan will have a copay of $35 or less through all phases of coverage. Please contact the drug plan for more details.

Click here to browse the Mutual of Omaha Rx Essential (PDP) Formulary.

The Mutual of Omaha Rx Essential (PDP)’s Initial Coverage Limit is $5,030. When this limit is reached, you exit the Initial Coverage Phase and enter the Coverage Gap (or Donut Hole).

The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 75% of your generic drug prescription costs in the donut hole on your behalf.

The brand-name drug manufacturer will pay 70% and your plan will pay an additional 5% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 75% discount. The 70% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts. Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has "No Gap Coverage". This plan (Mutual of Omaha Rx Essential (PDP)) offers No Coverage during the Coverage Gap phase.





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  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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