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Mutual Income Solutions Product Guide


A strategic alliance in Medicare excellence

As a customer-focused company, Mutual of Omaha is committed to offering a comprehensive suite of senior health products that help meet customers' individual needs.

We're excited to announce that Mutual of Omaha and Wellcare have continued their strategic alliance to deliver high quality Medicare Advantage plans in 2025.

Mutual of Omaha and Wellcare will be offering MAPD PPO plans in Georgia, South Carolina, Washington, and in the Dallas-Fort Worth and Houston markets in Texas.

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Product Information

Dallas/Ft. Worth

Available in Collin, Dallas, Denton, Ellis, Fannin, Hamilton, Hill, Hood, Jack, Johnson, Mills, Parker, Rockwall, Somervell, Tarrant and Wise counties.

Wellcare Mutual of Omaha Simple Secure Open (PPO)

Contract Number
  

H7323011000

  
INN/OON/Tier

INN

  

OON
Total Premium (Part C Part D)
  

$0.00

  
Inpatient Acute

$305 copay per day
for days 1-5
$0 copay per day
for days 6-90
No additional hospital days

  

$525 copay per day
for days 1-5
$0 copay per day
for days 6-90
No additional hospital days
Plan Deductible
  

No

  
Maximum Out of Pocket (MOOP) INN

$4,900

  

N/A
Maximum Out of Pocket (MOOP) Combined
  

$9,000

  
PCP Office Visits

$0

  

$25
Specialist Office Visits

$5

  

$50
Wellcare Spendables™
  

OTC Allowance of $30 per quarter for covered items

  
Fitness
  

$0

  
Dental Benefits

Preventive dental care and services ($0 copay)

  

Preventive dental care and services (50% cost share)
Vision Benefits

$0 copay for a routine exam, plus get up to $100 for unlimited contacts, glasses, lenses, and/or frames per year

  

40% coinsurance for a routine exam, 40% coinsurance for eyewear/services and get up to $100 towards unlimited contacts, glasses, lenses, and/or frames per year
Hearing Allowance
  

$350 - hearing aids per ear every year ($0 copay INN/40% cost share OON)

  
Lab Services

$0-$50

  

30%
X-Ray Services

$75

  

30%
Prescription Drug Copays (Pref) T1/T2/T3/T4/T5/T6
  

$0/$0/25%/50%/28%/$0

  
RX Deductible
  

$420

  
RX Deductible Tiers
  

Tiers 3-5

  

*Agent/Broker use only. Confidential and proprietary. Not to be distributed or shared with Medicare beneficiaries. Distribution to any person or company is prohibited and may be grounds for contract termination. Final 2025 plan and benefit information may be discussed with beneficiaries on or after October 1.


Houston

Available in Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Grimes, Hardin, Harris, Jefferson, Liberty, Matagorda, Montgomery, Orange, Polk, San Jacinto, Trinity, Walker, Waller and Wharton counties.

Wellcare Mutual of Omaha Simple Secure Open (PPO)

Contract Number
  

H7323012000

  
INN/OON/Tier

INN

  

OON
Total Premium (Part C Part D)
  

$0.00

  
Inpatient Acute

$320 copay per day
for days 1-5
$0 copay per day
for days 6-90
No additional hospital days

  

$525 copay per day
for days 1-5
$0 copay per day
for days 6-90
No additional hospital days
Plan Deductible
  

No

  
Maximum Out of Pocket (MOOP) INN

$5,900

  

N/A
Maximum Out of Pocket (MOOP) Combined
  

$9,000

  
PCP Office Visits

$0

  

$25
Specialist Office Visits

$0

  

$50
Wellcare Spendables™
  

OTC Allowance of $30 per quarter for covered items

  
Fitness
  

$0

  
Dental Benefits

Preventive dental care and services ($0 copay)

  

Preventive dental care and services (50% cost share)
Vision Benefits

$0 copay for a routine exam, plus get up to $100 for unlimited contacts, glasses, lenses, and/or frames per year

  

40% coinsurance for a routine exam, 40% coinsurance for eyewear/services and get up to $100 towards unlimited contacts, glasses, lenses, and/or frames per year
Hearing Allowance
  

$350 - hearing aids per ear every year ($0 copay INN/40% cost share OON)

  
Lab Services

$0-$50

  

40%
X-Ray Services

$75

  

40%
Prescription Drug Copays (Pref) T1/T2/T3/T4/T5/T6
  

$0/$0/25%/50%/28%/$0

  
RX Deductible
  

$420

  
RX Deductible Tiers
  

Tiers 3-5

  

*Agent/Broker use only. Confidential and proprietary. Not to be distributed or shared with Medicare beneficiaries. Distribution to any person or company is prohibited and may be grounds for contract termination. The plan information contained in this document is pending government approval and subject to change. Final 2025 plan and benefit information may be discussed with beneficiaries on or after October 1.

Available in Appling, Atkinson, Bacon, Baker, Baldwin, Banks, Barrow, Bartow, Ben Hill, Berrien, Bibb, Bleckley, Brantley, Brooks, Bryan, Burke, Butts, Camden, Candler, Carroll, Catoosa, Charlton, Chatham, Chattahoochee, Chattooga, Cherokee, Clarke, Clayton, Clinch, Cobb, Coffee, Colquitt, Columbia, Cook, Coweta, Crawford, Crisp, Dade, Dawson, Decatur, DeKalb, Dodge, Dooly, Douglas, Echols, Effingham, Elbert, Emanuel, Evans, Fannin, Fayette, Floyd, Forsyth, Franklin, Fulton, Gilmer, Glascock, Gordon, Grady, Greene, Gwinnett, Habersham, Hall, Hancock, Haralson, Harris, Hart, Heard, Henry, Houston, Irwin, Jackson, Jasper, Jeff Davis, Jefferson, Jenkins, Johnson, Jones, Lamar, Lanier, Laurens, Liberty, Lincoln, Long, Lowndes, Lumpkin, Macon, Madison, Marion, McDuffie, McIntosh, Meriwether, Miller, Mitchell, Monroe, Montgomery, Morgan, Murray, Muscogee, Newton, Oconee, Oglethorpe, Paulding, Peach, Pickens, Pierce, Pike, Polk, Pulaski, Putnam, Quitman, Rabun, Randolph, Richmond, Rockdale, Schley, Screven, Seminole, Spalding, Stephens, Stewart, Talbot, Taliaferro, Tattnall, Taylor, Telfair, Thomas, Tift, Toombs, Towns, Treutlen, Troup, Turner, Twiggs, Union, Upson, Walker, Walton, Ware, Warren, Washington, Wayne, Webster, Wheeler, White, Whitfield, Wilcox, Wilkes, Wilkinson, and Worth counties.

Wellcare Mutual of Omaha Simple Open (PPO)

Contract Number
  

H0111001000

  
INN/OON/Tier

INN

  

OON
Total Premium (Part C Part D)
  

$0.00

  
Inpatient Acute

$375 copay per day
for days 1-7
$0 copay per day
for days 8-90
No additional hospital days

  

50% of the total cost
for days 1-90
Plan Deductible
  

No

  
Maximum Out of Pocket (MOOP) INN

$5,900

  

N/A
Maximum Out of Pocket (MOOP) Combined
  

$10,000

  
PCP Office Visits

$0

  

$30
Specialist Office Visits

$40

  

$55
Wellcare Spendables™
  

OTC Allowance of $75 per quarter for covered items

  
Fitness
  

$0

  
Dental Benefits

No annual prev max plus $2,000 in comp dental services, Incl. exams, fillings & minor restorative services ($0 copay)

  

No annual prev max plus $2,000 in comp dental services, Incl. exams, fillings & minor restorative services (50% cost share)
Vision Benefits

$0 copay for a routine exam, plus get up to $100 for unlimited contacts, glasses, lenses, and/or frames per year

  

40% coinsurance for a routine exam, 40% coinsurance for eyewear/services and get up to $100 towards unlimited contacts, glasses, lenses, and/or frames per year
Hearing Allowance
  

$500 - hearing aids per ear every year ($0 copay INN/40% cost share OON)

  
Lab Services

$0-$50

  

50%
X-Ray Services

$75

  

50%
Prescription Drug Copays (Pref) T1/T2/T3/T4/T5/T6
  

$0/$0/25%/46%/28%/$0

  
RX Deductible
  

$420

  
RX Deductible Tiers
  

Tiers 3-5

  

*Agent/Broker use only. Confidential and proprietary. Not to be distributed or shared with Medicare beneficiaries. Distribution to any person or company is prohibited and may be grounds for contract termination. Final 2025 plan and benefit information may be discussed with beneficiaries on or after October 1.

Available in Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Greenwood, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, McCormick, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, and York counties.

Wellcare Mutual of Omaha Simple Open (PPO)

Contract Number
  

H7326001000

  
INN/OON/Tier

INN

  

OON
Total Premium (Part C Part D)
  

$0.00

  
Inpatient Acute

$350 copay per day
for days 1-5
$0 copay per day
for days 6-90
$0 copay
for 10 additional hospital days

  

40% of the total cost
for days 1-90
0% of the total cost
for days 91-100
Plan Deductible
  

No

  
Maximum Out of Pocket (MOOP) INN

$4,150

  

N/A
Maximum Out of Pocket (MOOP) Combined
  

$6,200

  
PCP Office Visits

$0

  

$35
Specialist Office Visits

$20

  

$50
Wellcare Spendables™
  

OTC Allowance of $90 per quarter for covered items

  
Fitness
  

$0

  
Dental Benefits

No annual prev max plus $3,000 in comp dental services, Incl. exams, fillings, minor restorative services & dentures ($0-20% coinsurance)

  

No annual prev max plus $3,000 in comp dental services, Incl. exams, fillings, minor restorative services & dentures (50% cost share)
Vision Benefits

$0 copay for a routine exam, plus get up to $200 for unlimited contacts, glasses, lenses, and/or frames per year

  

40% coinsurance for a routine exam, 40% coinsurance for eyewear/services and get up to $200 towards unlimited contacts, glasses, lenses, and/or frames per year
Hearing Allowance
  

$750 - hearing aids per ear every year ($0 copay INN/40% cost share OON)

  
Lab Services

$0-$50

  

50%
X-Ray Services

$40

  

50%
Prescription Drug Copays (Pref) T1/T2/T3/T4/T5/T6
  

$0/$0/25%/43%/28%/$0

  
RX Deductible
  

$420

  
RX Deductible Tiers
  

Tiers 3-5

  

*Agent/Broker use only. Confidential and proprietary. Not to be distributed or shared with Medicare beneficiaries. Distribution to any person or company is prohibited and may be grounds for contract termination. Final 2025 plan and benefit information may be discussed with beneficiaries on or after October 1.

Available in Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Kittitas, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Whitman, and Yakima counties.

Wellcare Mutual of Omaha Simple Open (PPO)

Contract Number
  

H596500200

  
INN/OON/Tier

INN

  

OON
Total Premium (Part C Part D)
  

$0.00

  
Inpatient Acute

$400 copay per day
for days 1-5
$0 copay per day
for days 6-90
No additional hospital days

  

30% of the total cost
for days 1-90
Plan Deductible
  

No

  
Maximum Out of Pocket (MOOP) INN

$5,900

  

N/A
Maximum Out of Pocket (MOOP) Combined
  

$10,000

  
PCP Office Visits

$0

  

$25
Specialist Office Visits

$25

  

$50
Wellcare Spendables™

OTC Allowance of $91 per quarter for covered items

  

OTC Allowance of $91 per quarter for covered items
Fitness
  

$0

  
Dental Benefits

No annual prev max plus $1,500 in comp dental services, Incl. exams, fillings, minor restorative services & dentures ($0 copay)

  

No annual prev max plus $1,500 in comp dental services, Incl. exams, fillings, minor restorative services & dentures (50% cost share)
Vision Benefits

$0 copay for a routine exam, plus get up to $200 for unlimited contacts, glasses, lenses, and/or frames per year

  

40% coinsurance for a routine exam, 40% coinsurance for eyewear/services and get up to $200 towards unlimited contacts, glasses, lenses, and/or frames per year
Hearing Allowance
  

$500 - hearing aids per ear every year ($0 copay INN/40% cost share OON)

  
Lab Services

$0-$50

  

40%
X-Ray Services

$75

  

40%
Prescription Drug Copays (Pref) T1/T2/T3/T4/T5/T6
  

$0/$0/25%/50%/28%/$0

  
RX Deductible
  

$420

  
RX Deductible Tiers
  

Tiers 3-5

  

*Agent/Broker use only. Confidential and proprietary. Not to be distributed or shared with Medicare beneficiaries. Distribution to any person or company is prohibited and may be grounds for contract termination. Final 2025 plan and benefit information may be discussed with beneficiaries on or after October 1.

Wellcare Mutual of Omaha Premium Enhanced Open (PPO)

Contract Number
  

H5965007000

  
INN/OON/Tier

INN

  

OON
Total Premium (Part C Part D)
  

$96.00

  
Inpatient Acute

$200 copay
up to 90 days per admission

  

30% of the total cost
for days 1-90
Plan Deductible
  

No

  
Maximum Out of Pocket (MOOP) INN

$2,000

  

N/A
Maximum Out of Pocket (MOOP) Combined
  

$3,000

  
PCP Office Visits

$0

  

$0
Specialist Office Visits

$0

  

$0
Wellcare Spendables™

OTC Allowance of $45 per quarter for covered items

  

OTC Allowance of $45 per quarter for covered items
Fitness
  

$0

  
Dental Benefits

No annual prev max plus $1,500 in comp dental services, Incl. exams, fillings & minor restorative services ($0 copay)

  

No annual prev max plus $1,500 in comp dental services, Incl. exams, fillings & minor restorative services (50% cost share)
Vision Benefits

$0 copay for a routine exam, plus get up to $100 for unlimited contacts, glasses, lenses, and/or frames per year

  

40% coinsurance for a routine exam, 40% coinsurance for eyewear/services and get up to $100 towards unlimited contacts, glasses, lenses, and/or frames per year
Hearing Allowance
  

$350 - hearing aids per ear every year ($0 copay INN/40% cost share OON)

  
Lab Services

$0-$50

  

40%
X-Ray Services

$0

  

40%
Prescription Drug Copays (Pref) T1/T2/T3/T4/T5/T6
  

$0/$0/25%/50%/28%/$0

  
RX Deductible
  

$420

  
RX Deductible Tiers
  

Tiers 3-5

  

*Agent/Broker use only. Confidential and proprietary. Not to be distributed or shared with Medicare beneficiaries. Distribution to any person or company is prohibited and may be grounds for contract termination. Final 2025 plan and benefit information may be discussed with beneficiaries on or after October 1.

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