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Mutual of Omaha Rx Premier (PDP)

Mutual of Omaha Rx Premier (PDP) S7126-072 Plan Details
2 out of 5 stars

Mutual of Omaha Rx Premier (PDP) is a plan offered by Mutual of Omaha.
Plan ID: S7126-072.

$94.20
Monthly Premium

Mutual of Omaha Rx Premier (PDP) is a plan offered by Mutual of Omaha.
Plan ID: S7126-072.

Mutual of Omaha Rx Premier (PDP) S7126-072 Plan Details
2 out of 5 stars

Mutual of Omaha Rx Premier (PDP) is a plan offered by Mutual of Omaha.
Plan ID: S7126-072.

$94.20
Monthly Premium

Connecticut Counties Served

Fairfield Hartford Litchfield Middlesex New Haven New London Tolland Windham

Massachusetts Counties Served

Barnstable Bristol Hampden Berkshire Dukes Essex Franklin Hampshire Middlesex Nantucket Norfolk Plymouth Suffolk Worcester

Rhode Island Counties Served

Bristol Kent Newport Providence Washington

Vermont Counties Served

Addison Bennington Caledonia Chittenden Essex Franklin Grand Isle Lamoille Orange Orleans Rutland Washington Windham Windsor

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $505
Out of Pocket Max In-Network: $-1
Out-of-Network: N/A
Initial Coverage Limit $4660
Catastrophic Coverage Limit $7,400

Prescription Drug Costs and Coverage

The Mutual of Omaha Rx Premier (PDP) plan offers the following prescription drug coverage, with an annual drug deductible of $505 (excludes Tiers 1 and 2) per year.

Coverage
Cost
Coverage & Cost
Annual Drug Deductible $505 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail $1.00
  • Standard retail $8.00
  • Preferred cost-share mail order N/A
  • Standard mail order N/A
Generic
  • Preferred cost-share retail $10.00
  • Standard retail $17.00
  • Preferred cost-share mail order N/A
  • Standard mail order N/A
Annual Drug Deductible $505 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail N/A
  • Standard retail N/A
  • Preferred cost-share mail order N/A
  • Standard mail order N/A
Generic
  • Preferred cost-share retail N/A
  • Standard retail N/A
  • Preferred cost-share mail order N/A
  • Standard mail order N/A
Annual Drug Deductible $505 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share retail $3.00
  • Standard retail $24.00
  • Preferred cost-share mail order $2.50
  • Standard mail order $2.50
Generic
  • Preferred cost-share retail $30.00
  • Standard retail $51.00
  • Preferred cost-share mail order $25.00
  • Standard mail order $25.00
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