Does Medicare Part B cover ketamine therapy?
Medicare Part B covers Spravato (esketamine), the FDA-approved nasal spray form of ketamine, for treatment-resistant depression. It doesn't cover IV ketamine infusions. Here's what you need to qualify and how we make getting started easy.
The quick answer
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Spravato (esketamine): covered for adults with treatment-resistant depression who meet Medicare Part B's requirements.
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IV ketamine infusions: not covered for depression or other mental health conditions. IV ketamine is available at Golden Afternoon as a self-pay treatment.
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Your cost: You pay the Part B deductible, then 20% coinsurance per visit. A Medigap supplement plan often covers that 20%.
Spravato vs. IV ketamine coverage
| Treatment | FDA-approved for depression? | Medicare Part B coverage | Pre-authorization |
|---|---|---|---|
| Spravato (esketamine) nasal spray | Yes, for treatment-resistant depression | Covered | Usually not required |
| IV ketamine infusions | No (off-label) | Not covered | N/A — self-pay |
Spravato is esketamine, a form of ketamine that the FDA has approved as a nasal spray for depression. That approval is why insurance covers it while IV ketamine, which is used off-label for depression, isn't covered.
What Medicare Part B requires for Spravato
Medicare covers Spravato when it's medically necessary. To show that, you'll typically need:
- Be 18 or older with a diagnosis of major depressive disorder.
- Score in the moderate to severe range on the PHQ-9, a short depression questionnaire (a score of 10 or higher). We'll do this with you during your screening.
- Have tried at least two antidepressants from different classes (for example, an SSRI and an SNRI), each at an adequate dose and for long enough to judge whether it worked, without enough improvement.
- Have no medical conditions that rule out Spravato, which Dr. Jenn will review with you.
Not sure if you qualify? That's what the free screening is for.
How it works at Golden Afternoon
Free screening
A short, no-cost call with our team to talk about your history, check your eligibility and verify your Medicare Part B benefits.
Consultation with Dr. Jenn
A medical consultation with Dr. Jenn, our founder and medical director. It's billed to Medicare Part B, so you only pay your Part B deductible or 20% coinsurance.
We confirm your coverage
Original Medicare doesn't usually require pre-authorization for Spravato, but we confirm your Part B benefits and any supplemental plan before you start, so you know what to expect.
Treatment begins
You come in for Spravato sessions in one of our private, calming treatment rooms, with our medical team with you throughout.
Your treatment schedule
Twice a week for the first four weeks, then once a week. Dr. Jenn adjusts the schedule over time based on how you're responding. Plan on a little over two hours per visit, because you stay with us while the effects wear off. Plan a ride home, since you can't drive until the next day.
What Spravato costs with Medicare
Spravato is covered under Medicare Part B because it has to be given in a certified clinic, not taken at home. Once you've met your yearly Part B deductible, Medicare pays 80% of the approved amount and you pay 20% coinsurance for each visit.
If you have a Medigap (Medicare Supplement) plan, it often covers some or all of that 20%. Many patients with a supplement pay little or nothing per visit after the deductible.
The SPRAVATO withMe savings program can't be used with Medicare. Federal rules don't allow manufacturer savings programs for Medicare, Medicaid or other government insurance. We'll give you a cost estimate after we check your benefits.
Have a Medicare Advantage plan?
This page covers Original Medicare (Part B). Medicare Advantage plans (Part C) must cover what Original Medicare covers, but they set their own copays and may require pre-authorization. Contact us and we'll check your specific plan.
Frequently asked questions
Does Medicare Part B cover IV ketamine infusions?
No. Medicare Part B doesn't cover IV ketamine for depression or other mental health conditions, because IV ketamine isn't FDA-approved for those uses. Golden Afternoon offers IV ketamine as a self-pay treatment.
Does Medicare Part B cover Spravato?
Yes. Medicare Part B covers Spravato (esketamine) nasal spray for adults with treatment-resistant depression who meet its requirements.
What will Spravato cost me with Medicare?
After your yearly Part B deductible, you pay 20% coinsurance for each visit. If you have a Medigap supplement plan, it often covers some or all of that 20%. We'll give you an estimate after we check your benefits.
Can I use the SPRAVATO withMe savings program with Medicare?
No. Federal rules don't allow manufacturer savings programs for Medicare, Medicaid or other government insurance. A Medigap supplement plan is the most common way Medicare patients lower their cost.
What if I don't meet the requirements yet?
Book a free screening anyway. Dr. Jenn can talk through your options, including what you'd need to qualify and whether self-pay IV ketamine might be right for you.
What happens during a Spravato session?
You give yourself the nasal spray in one of our private treatment rooms while our medical team watches over you. You'll stay with us for at least two hours afterward while the effects wear off. You can't drive until the next day, so plan a ride home.
