Mutual of Omaha Rx Value


Medicare Plan Details

2019 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: South Carolina

Select your county to view the price for this plan

 


Plan Type

Prescription Drug (Part D)

 

Monthly Premium$27
Health Plan Deductible $185
Health Plan Max Out-of-Pocket Not Applicable
Nationwide Coverage includedNo
Hearing Coverage includedNo
Vision Coverage includedNo
Dental Coverage includedNo
Doctor Lookup Link
Plan Link http://mutualofomaharx.com

Benefits Highlights

Your Cost
Doctor visits Primary: 20% per visit

Specialist: 20% per visit
Transportation No
Preventive care $0 copay
Ground ambulance 20%
Medicare Part B drugs Chemotherapy: 20%

Other Part B drugs: 20%
Health plan deductible $185
Mental health services Inpatient 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%
Rehabilitation services Occupational therapy visit: 20%

Physical therapy and speech and language therapy visit: 20%
Skilled Nursing Facility In 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
Emergency care/Urgent care Emergency: 20% per visit (always covered)

Urgent care: 20% per visit (always covered)
Medical equipment/supplies Durable medical equipment (e.g., wheelchairs, oxygen): 20% per item

Prosthetics (e.g., braces, artificial limbs): 20% per item

Diabetes supplies: 20% per item
Inpatient hospital coverage 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
Monthly health plan premium Not Applicable
Outpatient hospital coverage 20% per visit
Foot care (podiatry services) Foot exams and treatment: 20%

Routine foot care: No
Optional supplemental benefits No
Other health plan deductibles? Yes
Diagnostic procedures/lab services/imaging Diagnostic tests and procedures: 20%

Lab services: 20%

Diagnostic radiology services (e.g., MRI): 20%

Outpatient x-rays: 20%
Wellness programs (e.g., fitness, nursing hotline) No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) Not Applicable
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions? No

 

Inpatient care $38.00
Dental services $42.00
All other services $111.00
Total Estimated Annual Costs $4,240
Outpatient prescription drugs $0.00
Total monthly estimated costs $353.20

 

Fixed Costs

Monthly Drug Plan Premium: $26.70
Monthly Health Plan Premium: Not Applicable

Estimated Costs

Estimated annual drug costs: $320.40

 

Drug Plan Customer Service Plan too new to be measured
Member Experience with the Drug Plan Plan too new to be measured
Drug Safety and Accuracy of Drug Pricing Plan too new to be measured
Summary Rating of Prescription Drug Plan Quality Plan too new to be measured
Member Complaints and Changes in the Drug Plan’s Performance Plan too new to be measured

 

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