Post-65 & Medicare Eligible Retiree Health Plan 2022

The Dartmouth College Medicare Supplement (DCMS) Plan is available to qualifying Dartmouth College retirees age 65 and above, and members who are Medicare eligible due to disability. 

The Medicare Supplement Plan will pay second after Medicare Parts A & B. These expenses are subject to a $250 deductible, followed by a 20% coinsurance, with a maximum of up to $200, for a total out-of-pocket expense of $450 for your medical services for the year.

Plan Overview

DCMS Plan Overview 2022
DCMS Summary of Benefits 2022
Dartmouth College Medicare Supplement (DCMS) Summary Plan Description (SPD) 2021 (2022 docs coming soon)

Prescription Drug Coverage

The Medicare Part D plan offered through Dartmouth College includes a flat *tiered co-payment for each prescription drug purchase, until you've met the annual $450 out of pocket maximum.

2022 Formulary - list of covered Medications - list is subject to change.

Key Features Include

  • Broad retail network of more than 69,000 pharmacies nationwide, including independent pharmacies and chain pharmacies such as CVS and Walgreens.
  • The same flexible prescription service for maintenance medications. 90-day supplies of maintenance medications may be filled through Express Scripts Medicare (PDP) mail service pharmacy or at a CVS Pharmacy.
    • *A Co-payment is a flat dollar amount that you pay out of pocket for each covered drug you purchase. The amount you pay out of your pocket for your prescription drugs will be determined by the table above, according to the tier (Generic, Preferred Brand or Non-Preferred Brand) your specific drug falls into.  To find out if your drug is on the formulary (list of Medicare Part D covered prescription drugs), or about any restrictions, please call Express Scripts Medicare Customer Care at 1.877.788.5810  24 hours a day, 7 days a week, or refer to the 2022 Express Scripts Medicare Drug Formulary (list is subject to change).

Eligibility & Medicare

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 enrolled in Medicare Part A and Part B, according to the rules outlined by the Social Security Administration.  You should not enroll in a separate Medicare Part D if you want to be covered on the DCMS plan.  The DCMS plan will pay second after Medicare Parts A & B and provides Medicare Part D prescription drug coverage as well.

For additional information on Medicare, you should visit 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

Medicare Income-Related Monthly Adjustment Amounts (IRMAA)

The Medicare Income-Related Monthly Adjustment Amount (IRMAA) is an amount you may pay in addition to your Part B or Part D premium if your income is above a certain level. The Social Security Administration (SSA) sets four income brackets that determine your (or you and your spouse’s) IRMAA. SSA determines if you owe an IRMAA based on the income you reported on your IRS tax return two years prior, meaning two years before the year that you start paying IRMAA. The income that counts is the adjusted gross income you reported plus other forms of tax-exempt income.

If you are expected to pay IRMAA, SSA will notify you that you have a higher Part B and or Part D premium.

2022 IRMA Rates

Helpful Medicare Summaries & Links

Active Employees becoming Medicare Eligible

If you are not a retiree and are eligible for Medicare (ex. because you are turning 65 or due to a disability), you should contact the Benefits Office for more information about coverage. 

Changing Your Election 

If you would like to change your election in the Dartmouth College Medicare Supplement (DCMS) Plan, you may do so during Open Enrollment or any time during the year if you have a qualify event.  You can do so by notifying the Benefits Office in writing within 31 days of your qualifying event.   

Who to Contact

For questions on Medicare, please visit either 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 about the DCMS Plan, you may contact Cigna Health Insurance:

  • Toll-free phone number: 1-855-869-8619 
  • Send claims to:  P.O. Box 182223, Chattanooga, TN 37422-7223
  • Website:

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:

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