Does Medicare Cover Ketamine Infusion for Depression?
Fair Square Medicare

Does Medicare Cover Ketamine Infusion for Depression?

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By Ford Carlisle

Nov 23, 2022

Ways to Cover Your Ketamine Therapy Costs

If you or your loved ones struggle with depression and haven't found relief from traditional medications, you might consider ketamine infusion therapy. This alternative mental health therapy has proven effective for individuals with treatment-resistant depression.

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But what exactly is ketamine infusion, and will your insurance plan help cover the costs?

Keep reading to find out. In this article, we'll answer all your questions about ketamine infusion therapy and discuss ways to get coverage.

What Is Ketamine Infusion Therapy?

Ketamine infusion is an FDA-approved therapy for treatment-resistant depression.

It involves a 40-minute procedure — in a hospital or clinical setting — in which a doctor administers ketamine intravenously.

Ketamine infusion therapy requires multiple sessions:

  • It begins with an induction period — the patient typically receives six infusions over 2-3 weeks

  • Then follows the maintenance period — the dosage is slowly reduced to one infusion every 2-6 weeks

How Much Does Ketamine Infusion Therapy Cost?

A single ketamine infusion costs between $450 and $500.

The total cost of the Ketamine infusion therapy — which includes six ketamine infusions, a pretreatment consultation, and post-treatment follow-ups — is around $4,500.

Exact treatment costs may vary depending on your healthcare provider.

Does Medicare Cover Ketamine Infusions?

No. Medicare doesn't cover ketamine treatments for mental health conditions — like depression, anxiety, or mood disorders.

However, Medicare does cover a derivative of ketamine known as esketamine (Spravato). Spravato is an FDA-approved intranasal spray used on patients with treatment-resistant depression.

Note: To get Medicare coverage for Spravato, you must be enrolled in Medicare Part D or any Medicare Advantage Plan that covers prescription drugs. (Medicare Parts A and B don't cover Spravato).

Do Private Insurance Companies Cover Ketamine Infusions?

Typically, no.

Most private insurance companies only cover ketamine as an anesthetic. They probably won't cover ketamine treatments for depression.

However, insurance might cover certain parts of your treatment — like doctor visits or medical exams.

The extent of your insurance coverage depends on your plan and provider.

How Can I Cover the Costs of Ketamine Infusions?

Here are some ways to make ketamine infusions more affordable:

  • Talk to your insurance provider

  • Look for out-of-network reimbursements

  • Provide a Superbill

  • Use HSA/FSA accounts

  • Look into Advance Care

  • Seek Veteran Support

  • Ask about installment payments

Let's look at each option in more detail.

1. Talk to Your Insurance Provider

Check whether your insurance provider covers ketamine therapy. Some offer coverage under specific circumstances:

  • For example, if your provider classifies the treatment as “an infusion of a generic drug,” they may be able to cover some out-of-pocket expenses

2. Look for Out-of-Network Reimbursements

See if your insurance provider reimburses out-of-network claims. Pay your clinical provider for the service and ask your insurance for a reimbursement.

Most insurance companies accept out-of-network claims for healthcare services — unless their policy states otherwise. But each insurance company has different rules regarding out-of-network coverage. Talk to your provider for more info.

3. Provide a Superbill

A Superbill is an itemized list of all services provided to a client. It includes detailed visit summaries, doctors' names, CPT codes, etc.

Request a Superbill from your doctor. You might need it to claim your out-of-network coverage or get financial assistance with doctor visits, medical exams, etc.

4. Use HSA/FSA Accounts

HSA (Healthcare Spending Account) and FSA (Flexible Spending Account) are pre-tax accounts that help you save money for qualified healthcare expenses. 

Paying for your ketamine therapy using these "pre-tax" dollars is like receiving a discount on your treatment.

Note: Stop HSA contributions at least six months before enrolling in Medicare to avoid potential tax penalties.

5. Look Into Advance Care

Advance Care provides patients with affordable medical financing options. The Advance Care Card offers interest-free financing, affordable monthly payments, and flexible terms.

Using Advance Care can help reduce up-front expenses.

6. Seek Veteran Support

The Ketamine Fund offers free ketamine therapy to veterans suffering from PTSD, anxiety, depression, and other treatment-resistant disorders.

7. Ask About Installment Payments

Ask your healthcare provider if they provide installment payment options. Enrolling in a payment plan can help you cover up-front treatment costs.

Will Ketamine Infusion Coverage Change in the Future?

It's possible! Insurance companies might decide to cover ketamine infusion therapy as more research shows its safety and effectiveness in treating depression. 

Several organizations are already trying to spark this change:

For example, a non-profit organization called the Ketamine Task Force works to make ketamine infusion therapy more accessible. Their goal is to get insurance providers to approve coverage for ketamine infusions and provide fair reimbursement rates to ketamine providers.

Takeaway

Ketamine infusion therapy is an effective depression treatment — with results lasting days or weeks. Talk with your doctor before starting or stopping treatment for depression. This content is for informational purposes only.

Currently, Medicare doesn't provide coverage of ketamine treatments for depression. But you can seek out-of-network reimbursements, HSA/FSA accounts, and other payment options to reduce your expenses.

If you need help, our team at Fair Square Medicare has your back. Our advisors can answer any questions you have about Medicare coverage.

Give us a call at 1-888-376-2028.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.


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