Does Medicare Cover Ketamine for Treatment-Resistant Depression?

January 24, 2023 by Jason Parks

Understandably, one of the biggest questions you may have about treating depression has to do with cost. Not only how much it costs, but how much of the cost can you get covered by insurance?

Medicare and Medicaid are the biggest sources of medical coverage in the U.S., so a prevalent question we face is: “Does Medicare or Medicaid cover ketamine infusions for treatment-resistant depression?

The answer is… not really, but sort of.

Medicare and Medicaid Will Cover Eligible Patients for Spravato

While Medicare and Medicaid typically do not cover ketamine infusions for depression, that doesn’t mean you don’t have access to treatments that are fully or partially covered.

Medicare Part D, Medicare Advantage, and Ohio Medicaid Plans do cover esketamine, also known as Spravato, if you meet the eligibility criteria.

Spravato is a derivative form of ketamine that is delivered via an intranasal spray. It is FDA-approved and has shown similar results on patients with treatment-resistant depression.

If the patient wishes to pursue IV Ketamine Infusions instead, Medicare and Managed Medicaid Plans, such as Caresource, United Health Care Community Plan and Buckeye Medicaid will cover the cost of an office visit to a medical professional, but not the treatment itself. With this coverage your initial exams will be covered and up to $200 of your Ketamine infusion could be covered as well.

There are other ways to get at least some coverage with public or private insurance, such as using a HSA/FSA, or seeking support for veterans. We always try to work with our patients and their insurance providers to make sure we’re providing the most safe, effective, and affordable ketamine treatments for depression and other mental health problems.

Medicare Does Not Cover Ketamine Infusions Specifically

Ketamine infusions have been shown to make a noticeable difference in treatment-resistant depression, but for much of the medical world, ketamine is still only recognized officially as an anesthetic.

So ketamine can be covered by Medicare when it is being used as an anesthetic, but that isn’t the same as a ketamine infusion for depression. In the way that we use ketamine for treatment-resistant depression, Medicare typically will not cover the treatment. In fact, Medicare does not cover ketamine as a treatment for any sort of mental health disorder.

This, of course, does not mean that ketamine infusions for treatment-resistant depression are not safe or effective. They have clinically proven to be both, or else they could not be prescribed at all. Ketamine is already FDA-approved as an anesthetic, but to get it re-approved for mental health treatment would cost millions of dollars and years of work, which most pharmaceutical companies have no real incentive to do when it is already available, effective, and prescribable off-label for depression treatment.

Contact Us to Learn More About Your Options

Our goal is to find and deliver the most effective treatment for your depression, and to give you a ray of hope when you feel like nothing else is working for you.

That’s why we are always willing to work with you, your insurer, and every option we have to make ketamine infusions and our other treatments available to you. Contact us today to find out how we can work with you, and get a free consultation while you’re at it.

At New Pathways Clinic our heartfelt mission is to establish a holistic mental wellness campus that touches the lives of individuals in the greater Cleveland, Columbus, and Cincinnati regions. We are dedicated to combining state-of-the-art mental health treatments, like Ketamine therapy infusions and Spravato nasal spray, with the expertise of compassionate mental health professionals to treat depression, anxiety, PTSD, migraines, and bipolar disorder.

Our unwavering commitment drives us to continuously evolve and adapt as the scientific landscape of ketamine research expands and diversifies, leading to innovative mental health treatments. We are determined to pave the way for a healthier future for Cleveland, central Ohio, and southern Ohio.

New Pathways Clinic also offers Semaglutide & Tirzepatide weight-loss shots, ketamine-assisted psychotherapy, and  ketamine/Spravato support groups for patients.

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