Mutual of Omaha Rx Value (PDP)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by Mutual of Omaha Rx
Additional Coverage

(none)

Overall Government Star Rating
No Rating
out of 5 stars

State: Georgia

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Plan Type

Prescription Drug (Part D)

 

$27
$435.00
No

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$10.00 copay$10.00 copay


Generic drugs :
$3.60 copay or 5% (whichever costs more)

Brand-name drugs :
$8.95 copay or 5% (whichever costs more)

Generic$15.00 copay$15.00 copay
Preferred Brand$30.00 copay
Non-Preferred Drug49%
Specialty Tier25%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

Not covered
Not covered
No Rating
No Rating
No Rating
No Rating
No Rating

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