Mutual of Omaha Rx Premier (Enhanced PDP) A 2023 Medicare Part D Plan Review
Mutual of Omaha Rx Premier is a 2023 Enhanced Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan (S7126-089) from Mutual of Omaha Rx that's available to beneficiaries enrolled in a Medicare Advantage plan without Part D benefits or Medicare Part A and/or Part B.
This Part D plan has an initial coverage limitOnce 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... of $4,660 and a $505.00 deductibleA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. that must be paid before cost-sharing begins. CMS rated this plan 2.0 (Below Average) out of 5 stars.
Key Takeaways
- Mutual of Omaha Rx Premier is an enhanced benefit Medicare Part D plan.
- Enhanced benefit plans have a higher actuarial value than basic benefit plans.
- Actuarial value simply refers to the percentage of cost covered by the plan.
- The monthly premiumA 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. is $80.00
- The annual deductible is $505.00.
- This Mutual of Omaha Rx plan does not offer additional coverage in the coverage gap (aka, "donut hole").
- This plan does not qualify for the Extra Help program's full low-income subsidySocial 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 and prescription costs vary widely from plan to plan, so if you have regular prescriptions it's important to carefully compare what your costs will be.
| Plan Basics | |
|---|---|
| Plan ID: | S7126-089 |
| Plan Type: | PDP |
| Plan Year: | 2023 |
| Premium: | $80.00/mo |
| Deductible: | $505.00/yr |
| Benefit Type: | Enhanced |
| Rx Gap Coverage: | No |
| Low Income Subsidy: | No |
| Availability: | See List |
| Insured By: | Mutual of Omaha Rx |
WARNING: Before enrolling in a Part D plan, take the time to evaluate the cost of your regular prescriptions.
Prescription Drug Plan Premium
Although Mutual of Omaha Rx Premier's monthly premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the premium details of this Mutual of Omaha Rx plan.
| Basic Part D Premium: | $39.20 |
| Supplemental Part D Premium: | $40.80 |
| Total Part D Premium: | $80.00 |
| Part D Premium with Full LIS Assistance: | $48.10 |
| Part D Premium with 75% LIS Assistance: | $56.10 |
| Part D Premium with 50% LIS Assistance: | $64.00 |
| Part D Premium with 25% LIS Assistance: | $72.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $505.00. This is the amount you must pay at the pharmacy before Mutual of Omaha Rx begins paying its share.
NOTE: The deductible does not apply to one or more drug tiers in this plan (see "Prescription Drug Plan Out-of-Pocket Costs" below).
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Mutual of Omaha Rx Premier has copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Tier | Preferred | Standard |
|---|---|---|
| 1 (Preferred Generic) | $1.00 copay (deductible does not apply) | $8.00 copay (deductible does not apply) |
| 2 (Generic) | $10.00 copay | $17.00 copay |
| 3 (Preferred Brand) | $45.00 copay | $47.00 copay |
| 4 (Non-Preferred Drug) | 45% | 47% |
| 5 (Specialty Tier) | 25% | 25% |
CMS Rating Marks and Our Review
This Medicare Part D plan gets 2.0 out of 5 stars overall. Here's our quick summary of how well Mutual of Omaha Rx Premier performs.
You have options, and this one is below average. Solving issues when a member has a problem getting their medications is critical, and Mutual of Omaha Rx Premier members say the plan does a good job when they call for help. This plan gets an excessive number of complaints from its members. Members report that their experience with this plan is below average. Measuring drug safety and the accuracy of drug pricing are one way we can measure quality, and this plan scores good at both.
Every plan covers drugs differently, so it's important to look at your total cost. There are enhanced benefit plans with a lower monthly premium than this one. That's okay if the plan covers your prescriptions at a better overall price. This plan does have an annual deductible, but one of the formularyA 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. tiers is excluded (see table above).
Each year Medicare rates drug plans (Part D) in several major categories. These ratings are designed to help you understand the quality of care and service you can expect if you join this plan:
| CMS Measure | Star Rating |
|---|---|
| Overall Plan Rating | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Plan Availability
Mutual of Omaha Rx Premier is available in the following states:
Contact Mutual of Omaha Rx
| Plan Website: | Mutual of Omaha Rx Plan Information |
|---|---|
| Formulay Information: | Mutual of Omaha Rx Formulary Information |
| Pharmacy Information: | Mutual of Omaha Rx Pharmacy Information |
| Prospective Members: | (800)961-9006 |
| TTY Users: | (800)584-6939 |
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 AdvantageMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). program on www.medicare.gov.
Citations & References
- Mutual of Omaha Rx, "http://www.mutualofomaharx.com", Last Accessed October 15, 2021
- Medicare.gov, "Drug coverage (part D)", Last Accessed September 21, 2022
- Medicare.gov, "What Medicare Part D drug plans cover", Last Accessed July 1, 2022
- Medicare.gov, "Medicare costs at a glance", Last Accessed June 11, 2022
- SSA.gov, "Understanding the Extra Help With Your Medicare", Last Accessed June 9, 2022
- CMS.gov, "Landscape Source Files", Last Accessed January 15, 2023
- CMS.gov, "Medicare Part C & D Performance", Last Accessed January 15, 2023
The 2023 Medicare Part D Plans for information on this page was last updated on .