Most Medicare prescription drug coverage (Part D) will pay a portion of your costs for antidepressants. Some people with low income, and who need assistance paying for prescription drugs, can qualify for Extra Help .
Some Part D plans have a $0 deductible , and Medicare sets a maximum deductible amount that can be assessed.
Because antidepressants are included in prescription drug protected classes, Medicare must pay for a brand name or generic option.
If you know you need an antidepressant medication for daily use, a prescription drug plan is likely what you need in most cases.
Antidepressants are covered by all prescription drug plans under Medicare.
Across the country, businesses and communities are increasing awareness about mental health and depression. As more older adults recognize depression and seek treatment, antidepressant prescriptions are recognized as a treatment option for depression.
If you’re new to antidepressants or considering them as a treatment for depression, it’s important to know that this type of medication is not a cure for depression. Many antidepressant options exist, and it’s not uncommon to try more than one to see how your body reacts.
However, most people that try antidepressants to treat depression do find a prescription that works for them. Does Medicare cover antidepressants? It’s important to know that you are covered if you have prescription drug coverage through Medicare.
Keep reading to learn more about antidepressants and Medicare coverage.
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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. Antidepressants were first developed in the 1950s. Their use has become progressively more common in the last 20 years.
Most prescription drug coverage will pay a portion of your costs for antidepressants. Some people with low income, and who need assistance paying for prescription drugs, can qualify for Extra Help. If you’re eligible for the program, Medicare may cover some or all of your prescription drug costs.
Medicare will pay for an antidepressant when your doctor prescribes it as part of your treatment. Also, you must be receiving care from a Medicare-approved doctor that confirms a clinical diagnosis of depression. Any prescription covered by Medicare cannot be experimental or alternative to the protected classes of prescription drugs.
When you have Part A and Part B benefits through Original Medicare or Medicare Advantage (Part C), you’re covered for most services. However, Part D is an optional prescription drug coverage needed for Medicare to cover antidepressants.
Here’s a closer look at Medicare coverage and when it pays for antidepressants.
Original Medicare covers the costs of services and supplies. Original Medicare allows you to add a Medicare Supplement Insurance (Medigap) plan to cover out-of-pocket expenses, but neither Part A, Part B or Medigap plans pay for antidepressants. Suppose you have Original Medicare and you add a stand-alone Part D plan to cover prescription drugs. In that case, Medicare will pay a portion of prescription drug costs, including 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 when you enroll in Part D after your Initial Enrollment Period.
Medicare Advantage (Part C) plans administer Part A and Part B through private insurance, and most offer extra benefits like prescription drug coverage (Part D). It’s important to know that Part D coverage with Medicare Advantage may have specific pharmacy networks. So, make sure the drugs you need are covered by the plan you choose when it’s time. Another critical difference is that Part D plans purchased in addition to Original Medicare includes a monthly premium . Your Part D coverage with a Medicare Advantage plan does not.
When Medicare pays for prescription drugs, Part D plans must cover prescriptions included in any of the six protected classes of prescription drugs. Because antidepressants are included in the protected classes, Medicare must pay for a brand name or generic option. In some cases, you may have to switch from a brand-name drug to a generic option. However, your medication would only change by name, and the generic drug would provide the same active drugs as your brand name option.
What do antidepressants usually cost?
Brand name antidepressants like Zoloft, Prozac and Paxil have generic equivalents that cost significantly less. For example, if you have met your Part D deductible, you could pay between $5 and $8 for your antidepressant prescription. Of course, your coverage and the types of prescription drugs can affect your costs.
Copayments or coinsurance will have to be paid on most prescriptions, in addition to premiums. Your plan also may carry an annual deductible. You’ll pay full price until you hit that deductible, after which Medicare starts paying its share.
Some Medicare prescription drug plans (Part D) may have a $0 deductible. However, each year Medicare sets a maximum deductible amount that can be assessed.
Does Medicare pay for prescription drugs?
Yes, Medicare pays a portion of your prescription drug costs with specific prescription drug plans (Part D). Private insurance companies sell Medicare Part D either as a stand-alone plan added to Original Medicare or included with Medicare Advantage plans.
Suppose you receive your Part A and Part B benefits through either Original Medicare or a Medicare Advantage plan. In these cases, some drugs you receive at a hospital (inpatient) or in a facility (outpatient) are covered. However, prescription drugs from a pharmacy will always be covered by Part D.
The list of medications covered by Medicare is called a formulary. Each plan’s formulary provides the generic and brand-name drugs available. Formularies vary from plan to plan, but each is required by law to include at least two drugs in the most commonly prescribed categories. Among these categories, antidepressants are included along with HIV/AIDS drugs, immunosuppressant drugs, cancer drugs and others.
Medicare Part D does not pay for over-the-counter drugs, such as cold medicines or antacids, even if prescribed as a treatment.
Is Zoloft covered by Medicare?
Zoloft coverage may vary based on plan availability. Before choosing a Part D plan, you should compare the plans available in your area to ensure they cover Zoloft or Sertraline. Sertraline is the generic form of the medication Zoloft. Sertraline is used to treat major depressive disorders, obsessive compulsive disorder, PTSD, panic disorder, premenstrual dysphoric disorder and social anxiety disorder.
Antidepressants are covered by all prescription drug plans (Part D) under Medicare. Medicare prescription drug plans each have their formulary or drug list, which details the plan’s drugs and how they are covered.
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If you know you need an antidepressant medication for daily use, a Medicare prescription drug plan (Part D) is likely what you need in most cases.
Your choices for Part D and what you’ll pay for coverage depend on whether you receive your Part A and Part B benefits through Original Medicare or they’re administered by a private Medicare Advantage (Part C) insurance plan.
What if you choose Original Medicare? Part D coverage with Original Medicare must be added as a stand-alone plan. So, your part D coverage will come with a monthly premium in addition to the monthly premium you pay for Part A and Part B.
What If you choose a Medicare Advantage plan? Part D coverage is included with most Medicare Advantage plans. So, your Part D coverage will not have an additional premium. However, your Medicare Advantage Part D plan may have a specific pharmacy network.