2019 Mutual of Omaha Rx Value (PDP) S7126-51-0 in AR from OMAHA HEALTH INSURANCE COMPANY | HealthPocket

Mutual of Omaha Rx Value (PDP)

$33/mo

Apply For This Plan

Zip Code72209
Applicant3/24/1984 Male
Coverage Start3/25/2019
Apply Now

Benefits & Coverage

Insurance TypeMedicare Advantage Prescription Drug Plan (Part D)
Insurance ProviderOMAHA HEALTH INSURANCE COMPANY
Plan IDS7126-51-0
Plan Year2019
CMS RatingNot Rated
Plan TypePDP
Annual Deductible$415.00

What To Know About This Plan
  • This is a drug coverage only plan

Why We Like This Plan
  • has a copay of $1 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

Costs and Other Important Information

Plan Year2019
Monthly Health Plan PremiumNot Applicable
Monthly Drug Plan Premium$33.60
Health Plan Deductible$185
Other health plan deductibles?Yes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)Not Applicable
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverageIn 2019 the amounts for each benefit period are:
$1,364 deductible for days 1 through 60
$341 copay per day for days 61 through 90
Outpatient hospital coverage20% per visit
Doctor visitsPrimary:20% per visit
Specialist:20% per visit
Preventive care$0 copay
Emergency care/Urgent careEmergency:20% per visit (always covered)
Urgent care:20% per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:20%
Lab services:20%
Diagnostic radiology services (e.g., MRI):20%
Outpatient x-rays:20%
Mental health servicesInpatient hospital - psychiatric:In 2019 the amounts for each benefit period are:
$1,364 deductible for days 1 through 60
$341 copay per day for days 61 through 90
Outpatient group therapy visit with a psychiatrist:20%
Outpatient individual therapy visit with a psychiatrist:20%
Outpatient group therapy visit:20%
Outpatient individual therapy visit:20%
Skilled Nursing FacilityIn 2019 the amounts for each benefit period are:
$0 copay for days 1 through 20
$170.50 copay per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:20%
Physical therapy and speech and language therapy visit:20%
Ground ambulance20%
TransportationNo
Foot care (podiatry services)Foot exams and treatment:20%
Routine foot care:No
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):20% per item
Prosthetics (e.g., braces, artificial limbs):20% per item
Diabetes supplies:20% per item
Wellness programs (e.g., fitness, nursing hotline)No
Medicare Part B drugsChemotherapy:20%
Other Part B drugs:20%

Benefits Services

Hearing
Hearing exam20%
Preventive Dental
Comprehensive Dental
Vision

Coverage Area for Mutual of Omaha Rx Value (PDP)

StateArkansas
CountyPulaski

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$1 copay$5 copayNot offered
Tier 2: Non-Preferred Generic$4 copay$10 copayNot offered
Tier 3: Preferred Brand Name15% coinsurance18% coinsuranceNot offered
Tier 4: Non-Preferred Brand Name32% coinsurance35% coinsurance35% coinsurance
Tier 5: Specialty Tier25% coinsurance25% coinsurance25% coinsurance

90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$3 copay$15 copay$2 copay
Tier 2: Non-Preferred Generic$12 copay$30 copay$8 copay
Tier 3: Preferred Brand Name15% coinsurance18% coinsurance18% coinsurance
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier

Pharmacies that accept Mutual of Omaha Rx Value (PDP) Prescription Drug Plan for Arkansas

/
Please select the correct zip

No results found. Try changing the search distance or zip code.

WellCare Premier (PPO)
COST:from $0CMS Rating:Not Rated
Select
Cigna-HealthSpring Preferred AR (HMO)
COST:from $0CMS Rating:
Select
HumanaChoice H5216-139 (PPO)
COST:from $0CMS Rating:
Select
Advantra Freedom (PPO)
COST:from $0CMS Rating:
Select
AARP MedicareComplete Plan 1 (HMO)
COST:from $0CMS Rating:Not Rated
Select

get free advice

Speak With A Licensed Agent

Call (800) 931-6467

Learn More

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.