Does Medicare Cover Antidepressants?
Key Takeaways
- Medicare prescription drug coverage (Part D) will pay a portion of the costs for antidepressants.
- Some people who need assistance paying for prescription drugs, can qualify for Extra HelpExtra Help is a financial assistance program that helps people with low incomes pay for Medicare Part D coverage. .
- Because antidepressants are included in prescription drug protected classes, plans must pay for a brand name or generic option.
While they’re not a cure for depression, antidepressant prescriptions are a vital treatment option that can make a big difference in people’s lives. It’s not uncommon to try more than one medication, under a healthcare provider’s supervision, to see how your body and symptoms react.
Original Medicare, the public health insurance program for U.S. adults who are over 65 or have certain disabilities, generally does not cover prescription medications for use at home. You will need Medicare Part D prescription drug coverage through a private insurance carrier to help with the costs of antidepressants.
Keep reading to learn more about antidepressants and Medicare coverage.
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What Is an Antidepressant?
Antidepressants are medications that can help relieve symptoms of depression, social anxiety disorder, anxiety disorders, seasonal affective disorder, and dysthymia (also called chronic depression), as well as other conditions.
Antidepressants are prescribed to correct chemical imbalances of neurotransmitters in the brain that are believed to be responsible for changes in mood and behavior. First developed in the 1950s, antidepressant have become an increasingly common treatment over the years.
When Does Medicare Pay for Antidepressants?
Original Medicare covers the costs of medical services and supplies, but not most prescription drugs you take at home. Original Medicare will generally only pay for an antidepressant when your doctor prescribes it as part of your treatment in clinical setting. For other medications, you can add a standalone Medicare Part D prescription drug plan from a private insurance carrier.
What drugs are covered and the costs you pay vary by plan. However, all Part D plans must cover prescriptions in six protected classes, which include antidepressants.
If you have Medicare coverage but did not enroll in a Part D plan when you were first eligible, you still have options available. However, you will have to pay an enrollment penalty if you delayed joining a Part D plan and didn’t have prescription drug coverage from another source.
Some people with low incomes who need assistance paying for Part D coverage can qualify for Extra Help. If you’re eligible for the program, you may be able to receive coverage with no monthly premium, no annual deductible, and low copays at participating pharmacies.
Medicare Advantage (Part C) plans are offered by private insurance carriers to substitute for Medicare Part A and Part B. Medicare Advantage Prescription Drug Plans include Part D coverage, and plans may feature other benefits. Medicare Advantage plans may require you to visit doctors and pharmacies in a provider network to get the most out of your benefits.
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What do Antidepressants Cost With Part D Coverage?
You’ll be responsible for copayments or coinsurance for most covered prescriptions, in addition to paying your monthly premiums for a Medicare Part D or Medicare Advantage Prescription Drug plan. Your plan also may set an annual deductible. You’ll pay full price until you hit that deductible, after which Medicare starts paying its share.
Is Zoloft Covered by Medicare?
Antidepressants are covered by all Medicare Part D prescription drug plans. Plans each have their formulary or drug list, which details what drugs are covered and how much you’ll pay.
Coverage for Zoloft or any other specific drug may vary based on your plan. Before choosing a Part D plan, you should compare the coverage for medications you’ve been prescribed. Keep in mind that Sertraline is the generic form of Zoloft, often used to treat major depressive disorders, obsessive compulsive disorder, PTSD, panic disorder, premenstrual dysphoric disorder and social anxiety disorder.
Sources
- Prices for Popular SSRIs. GoodRx.com.
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