Mutual of Omaha | Important Information Regarding 2021 PDP Plan Offerings

September 14, 2020

For the 2020 plan year, Mutual of Omaha Rx offers two Prescription Drug Plans – the Value and Plus plans. For 2021, we will continue to offer the Plus plan but will be ceasing the Value plan and introducing a new low premium plan called Premier.

We are discontinuing the Value plan due to poor claims experience, which would have forced us to increase premiums significantly in 2021. These premium changes would have made the Value plan uncompetitive.

Mutual of Omaha

How does this impact your current Value Plan clients?

We will be crosswalking (or moving) members from the Value plan to the Plus plan with an effective date of January 1, 2021. While disruptive for members, this is the best move for the long-term viability of our PDP products. We chose not to crosswalk the Value block to the new Premier as this action would not have remedied the issue of high claim cost brought on by too many high-cost members currently in the Value plan. Additionally, it is our understanding that CMS prefers crosswalks to point to a Basic plan (to avoid disrupting low-income member premium subsidies).

However, Value members are free to enroll in the new Premier plan during AEP. The new Premier plan may be a very good fit for many of your clients. Value members who choose to do nothing will be enrolled in the Plus plan for 2021, which will mean an increase in their premiums. It is imperative that current Value members review their coverage options.

Member Communications:

Members will be notified of this crosswalk through their ANOC letter from the Center for Medicare and Medicaid Services (CMS). In addition, Mutual will be sending letters and emails to those impacted members. Our intent is to help members to fully understand what they must do if they don’t want to be crosswalked to the Plus Plan. Both the CMS ANOC letter and Mutual member letter are scheduled to be in-home by October 1, 2020.

The Mutual letter to members will let them know they can switch to the new Premier plan for 2021. They will be reminded to complete a new enrollment form for the Premier plan during the Annual Enrollment Period – October 15 to December 7, 2020. If you are the agent of record, they will also be provided with your information – name, phone, and email – to contact.

New Premier Plan

Premier is a low premium enhanced plan that will be competitive for members who are aging in or on a few generic medications. We have made changes to the formulary and benefits to attract a better risk profile on Premier.

The Premier plan offers affordable, reliable prescription drug coverage with:

  • Low premium
  • $0 Tier 1 copays at preferred pharmacies
  • $0 deductible on Tiers 1 and 2
  • Access to more than 67,000 pharmacies nationwide

On average the premiums for the two 2021 plans are as follows:

  • Premier premiums in the low to mid $20s
  • Plus premiums will be around $80,

Remember PDP plans for the 2021 plan year cannot be marketed prior to October 1, 2020. This includes contacting current clients or prospects and discussing any options, rates, or benefits for the coming plan year. Also, the earliest an enrollment for the 2021 plan year can be submitted is October 15, 2020.

If you have questions, please email us at seniorhealthsales@mutualofomaha.com.

For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881


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