|DCMS Eligibility & Medicare|
|Plan Details and Summaries|
|Changing Your Election|
|Who to Contact|
|Helpful Medicare Summaries|
|Benefits Office Contacts|
|Retiree Benefits Vendors|
|COBRA and Continuing Benefits|
The DCMS Plan is available to eligible Dartmouth College Medicare eligible retirees age 65+, and members who are Medicare eligible due to disability. Please find below, a brief summary of the benefit changes for the 2016 plan year.
There will be no change to the annual DCMS out of pocket maximum. The annual out of pocket maximum per member for covered services is $900. This includes up to $450 toward medical costs and up to $450 toward prescription costs each year. This will not change for 2016.
2016 DCMS premium rate change
There will be a 9% increase in the DCMS premium rate for 2016 for covered members. Beginning January 1, 2016 the DCMS plan premium will be $439.58 per member per month. This change will be reflected in the monthly statement you receive mid-January for your January 2016 benefits. Those who do not owe a household balance do not receive a monthly statement.
SilverScript® Prescript Drug Cost Share change
To continue offering affordable prescription drug coverage, the out of pocket cost share will change from the current 30% coinsurance to a flat *copayment structure for Generic, Preferred and Non-Preferred Brand drugs. This means that beginning January 1, 2016 when you go to the pharmacy to purchase your prescription drugs, the amount you pay out of your pocket will be determined by the table below, according to the tier your specific drug falls into. To find out if your drug is on the formulary (list of Part D prescription drugs), or about any restrictions, please call SilverScript Customer Care at 1‑866‑693‑4621. Please read the annual enrollment materials sent to you from SilverScript for details about your plan. You can find additional information at dartmouth.silverscript.com.
|Retail Pharnacy||Generic||Preferred Brand||Non-Preferred Brand|
|1-30 day supply||$5||$25||$40|
|31-60 day supply||$10||$50||$80|
|61-90 day supply||$15||$75||$120|
|Mail Order||Generic||Preferred Brand||Non-Preferred Brand|
|1-90 day supply||$10||$50||$80|
* A Copayments is a flat dollar amount that you pay out of pocket for each covered drug you purchase.
In order to be eligible for the Dartmouth College Medicare Supplement (DCMS) Plan, you must meet the minimum qualifications for the DCMS plan, and be eligible for Medicare according to the rules outlined by the Social Security Administration.
You should enroll in Medicare Parts A & B. You should not enroll in a separate Medicare Part D if you want to be the on the DCMS plan. The DCMS plan will supplement Parts A & B and provide a Medicare Part D plan as well.
For more information on Medicare, you should visit the Social Security Administration website or contact your local Social Security Office. You can find your local office by visiting the Social Security Administration office locator website.
As stated above, the Medicare Supplement Plan will supplement Medicare Parts A & B. These expenses are subject to a $250 deductible, followed by a 20% coinsurance to a maximum of $200, a total out-of-pocket expense of $450 for your medical services for the year.
The Medicare Part D plan offered through Dartmouth College includes a 30% coinsurance payment for each prescription, until you've met the annual $450 out of pocket maximum.
Further detail is available in the following resources:
You may also wish to refer to the Benefits Terminology and Definitions for further clarification of the terminology referenced on this page.
If you are not a retiree and are eligible for Medicare (ex. due to a disability), you should contact the Benefits Office for more information on your costs.
If you would like to change your election in the Dartmouth College Medicare Supplement Plan, you may do so at any time. However, as long as you are enrolled in Medicare, this is the only plan you are eligible to elect through Dartmouth College.
If you wish to make this change, you must do so by notifying the Benefits Office in writing (Note: E-mails are accepted.)
2016 Medicare & You booklet
Who Pays First (Medicare Coordination of Benefits Summary)
Higher Income Beneficiary Rules (IRMAA premiums)
IRMAA Premium Reimbursement Form
Medicare Extra Help program
TriCare for Life Handbook
For questions on Medicare, please visit either Medicare.gov or the Social Security Administration website or contact your local Social Security Office. You can find your local office by visiting the Social Security Administration office locator website.
For questions on coverage for the Dartmouth College Medicare Supplement Plan, you should contact Cigna Health Insurance:
If you would like to make changes to your coverage or have questions on your eligibility for the DCMS plan, you should contact the Benefits Office:
Last Updated: 10/9/15