On this page we help consumers: Compare Mutual of Omaha Rx Value, a 2020 Medicare Prescription Drug Plan (PDP) available in Texas for $22.70/month with a $435.00 deductible, with all Medicare Part D Plans in TX.
According to the Centers for Medicare and Medicaid Services (CMS), this plan's quality is New Plan, Not Yet Rated, and rated it 0.0 out of 5.0 stars.
These are the areas of the plan that are important to compare and review:
- Premium & Deductible: The premium is the amount you will pay monthly. Plud, many plans have an annual deductible that must be met before cost sharing begins.
- Coverage Phases: Part D plans have an initial coverage limit, followed by a coverage gap, and then catastropic coverage. Some plans offer some coverage in the gap.
- Co-pays & Co-insurance: If you have regular prescriptions, it's critical to verify that your drugs are covered and to know what you will pay at the pharmacy.
- CMS Ratings: Important measurements across 4 different areas that will help you understand how well this plan will care for you.
This is a cost sharing based prescription drug plan (PDP). With the Mutual of Omaha Rx Value PDP you have several different costs, including the premium (monthly), a deductible (annual), and pharmacy co-pays and/or co-insurance.
The monthly premium is $22.70 ($272.40 paid annually). It breaks down as follows:
This plan is not available to people receiving full Low Income Subsidy (LIS) benefits.
The annual deductible is $435.00.
For 2020, the maximum Part D deductible is $435. A plan with the maximum deductible does not necessarily mean that it is more expensive than a plan with a lower deductible or no deductible at all. You need to consider all costs.
You Pay the Premium + Deductible + Copayments
Be aware that you must continue to pay your monthly premium even when you are not using any medications. Also, it's important to plan ahead because you are responsible for one hundred percent of your prescription costs until the plan's deductible has been met. You also make the required copayment when you pickup your prescriptions. These are your share of the prescription drug costs. The plan pays the rest until you reach the coverage gap (aka, “donut hole”).
What You Pay Could Be Different
There are two conditions that could affect how much you pay for this plan. If you qualify for the Social Security Extra Help program your premium will generally be lower. Also, if you enrolled late the Centers for Medicare and Medicaid Service may impose a premium penalty. Contact your local Texas Medicare Insurance Agent to get an exact quote for your situation.
Mutual of Omaha Rx Value is a Enhanced PDP. At a minimum, Mutual of Omaha Rx must offer a "standard benefit" package mandated by law. The standard benefit includes an annual deductible and a gap in coverage, aka, donut hole. Carriers may also offer plans that:
- are actuarially equivalent to the standard benefit; or
- are enhanced, offering benefits in addition to the standard benefit.
Typically, enhanced plans offer additional coverage during the coverage gap. If you fell into the donut hole last year, shop enhanced plans.
Initial Coverage Limit
Confused about the initial coverage limit? Don't be, because it's straight forward. If you enroll in the Mutual of Omaha Rx Value PDP, you share the cost of your prescriptions with Mutual of Omaha Rx. You each pay your share until the amount spent at the pharmacy reaches $4020.00 (retail spending amount). That's the initial coverage limit in Texas for plan year 2020. After that you are not covered (coverage gap) until your actual out-of-pocket costs qualify you for catastrophic coverage. Keep reading, because you are entitled to automatic discounts.
Coverage Gap (aka, Donut Hole)
The coverage gap, or donut hole, as it is often called, is the coverage phase where you no longer receive assistance from the plan. In other words, you pay for your prescriptions out-of-pocket. How quickly you reach the coverage gap with Mutual of Omaha Rx Value all depends on your prescriptions. Most seniors never fall into the donut hole.
When you're in the donut hole you pay all of the costs for your medications, but at a discounted rate (75% off of both brand-name drugs and generics). You continue to pay this until your out-of-pocket costs reach $6,350. At this point, Medicare takes over by giving you catastrophic coverage. The $4,550 out-of-pocket figure does not include your monthly premiums or what Mutual of Omaha Rx pays.
Additional Gap Coverage
Mutual of Omaha Rx Value offers some additional assistance in the coverage gap. See the plan's Summary of Benefits for details. If you reached the coverage gap last year and were not able to afford your medications, be sure to check with your local Texas Medicaid office. You may qualify for additional assistance. The Social Security Administration's Extra Help program is another opportunity for seniors on Medicare who are not able to afford their prescriptions.
Copayment & Coinsurance Details
In addition to the monthly premium and annual deductible, the Mutual of Omaha Rx Value prescription drug plan has copayments (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the schedule for this plan:
|1 (Preferred Generic)||$0.00 copay||$10.00 copay|
|2 (Generic)||$2.00 copay||$15.00 copay|
|3 (Preferred Brand)||$26.00 copay||$31.00 copay|
|4 (Non-Preferred Drug)||48%||50%|
|5 (Specialty Tier)||25%||25%|
IMPORTANT: In order to determine if this is the best PDP for you, it's critical that you look up your prescriptions in the plan's formulary.
Medicare Part D Star Ratings
In this section we show you the quality rating for this plan. Each year the Centers for Medicare and Medicaid Services (CMS) rates prescription drug plans in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this Mutual of Omaha Rx plan.
|2020 Overall Rating|
|Drug Plan Customer Service||Plan too new to be measured|
|Complaints and Changes in the Drug Plan||Plan too new to be measured|
|Member Experience with the Drug Plan||Plan too new to be measured|
|Drug Safety and Accuracy of Drug Pricing||Plan too new to be measured|
Contact Mutual of Omaha Rx
Here's the new member contact information for Mutual of Omaha Rx:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part D program on www.medicare.gov or the Wikipedia page. For information about the SSA's Extra Help program, download the Understanding Extra Help guide.
If you are entitled to Medicare Part A (enrolled or not) or currently enrolled in Medicare Part B you may join the Mutual of Omaha Rx Value prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Houston, San Antonio, Dallas, Austin, Fort Worth, El Paso, Arlington, Corpus Christi, Plano, Laredo, Lubbock, Garland, Irving, Amarillo, Grand Prairie, Brownsville, Pasadena, McKinney, Mesquite, McAllen, Killeen, Frisco, Waco, Carrollton, Denton, Midland, Abilene, Beaumont, Round Rock, Odessa, Wichita Falls, Tyler, Richardson, Lewisville, and all other towns and cities in Texas.