Mutual of Omaha Rx Premier is a 2.5 Star Medicare Part D Plan for Medicare Beneficiaries in Oklahoma
The Centers for Medicare & Medicaid Services (CMS) evaluated this Medicare Part D plan's previous year performance and rated it 2.5 out of 5 stars (Below Average) for quality.
These are the areas of the plan that are important to compare and review:
- Premium & A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share....: The premium is the amount you will pay monthly. Plus, many plans have an annual deductible that must be met before An amount patients pay for their share of the cost of medical service or supply, like a doctor’s visit, hospital inpatient visit, or prescription drug.... begins.
- Coverage Phases: Part D plans have an Once you have met your yearly deductible, you will pay a copayment or coinsurance for each covered drug until you reach the initial coverage limit. You will then enter your plan’s coverage gap (aka, “donut..., followed by a A period of time in which you pay higher cost-sharing for prescription drugs until you spend enough to qualify for catastrophic coverage...., 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 Premier PDP you have several different costs, including the premium (monthly), a deductible (annual), and pharmacy co-pays and/or co-insurance. This plan's annual premium is $336.00 ($28.00 paid monthly). It's priced as follows:
Low-Income Subsidy ("Extra Help")
This plan does not qualify for Extra Help (Social Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium...) benefits.
This plan has a $445.00 deductible (annual).
For 2021, 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 pick up 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 is a public health insurance program that provides health care coverage to low-income families and individuals in the United States.... Service may impose a premium penalty. Contact your local Oklahoma Medicare Insurance Agent to get an exact quote for your situation.
Mutual of Omaha Rx Premier 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 Premier 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 $4130.00 (retail spending amount). That's the initial coverage limit in Oklahoma for plan year 2021. After that, you are not covered (coverage gap) until your actual Out-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments.... 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 Premier all depends on your prescriptions. Most seniors never fall into the donut hole.
If you reach the ICL (most people don't), then you are responsible for 100% of your prescription costs until your out-of-pocket costs hit $6,350 (excluding your monthly A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. ... and the amount paid by the plan). This is called the coverage gap or donut hole. The good news is that you get a 75% discount on your brand-name prescription drugs and your generic medications while you're in the gap. You get to the other side of the donut hole when you've spent $6,350, at which point you automatically qualify to receive catastrophic coverage from Medicare.
Additional Gap Coverage
Mutual of Omaha Rx Premier does not offer additional assistance in the coverage gap. If you reached the coverage gap last year and were not able to afford your medications, be sure to check with your local Oklahoma 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 Premier prescription drug plan has A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service.... (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the schedule for this plan:
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 A formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered.....
Medicare Part D Star Ratings
In this section we show you the quality rating for this plan. Each year the The Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs.... (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.
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 is Medicare's prescription drug plan program. Plans are offered by private insurance companies and cover outpatient prescriptions.... program on www.medicare.gov. For information about the SSA's Extra Help program, download the Understanding Extra Help guide.
This stand-alone Medicare Part D plan is compatible with Medicare Part A is hospital inpatient coverage for people with Original Medicare, whereas Part B is medical coverage for doctor visits, tests, etc.... (hospital insurance) and Medicare Part B is medical coverage for people with Original Medicare. It covers doctor visits, specialists, lab tests and diagnostics, and durable medical equipment. Part A is for hospital inpatient care.... (medical insurance), and all Oklahoma Medigap plans. It's also compatible with Medicare Part C plans in Oklahoma, so long as the plan does not include prescription drug coverage.
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 Premier prescription drug plan. Unless you also receive benefits from Medicaid, enrollment in a Part D plan is voluntary. This plan is available in Oklahoma City, Tulsa, Norman, Lawton, Broken Arrow, Edmond, Enid, Stillwater, Muskogee, and all other towns and cities in Oklahoma.