Does Medicare cover Spravato? Yes. Here's what you'd pay.
Medicare covers Spravato for treatment-resistant depression, and our Medicare patients usually pay $40 a treatment. We accept Original Medicare and every Medicare Advantage plan except UnitedHealthcare's, and we handle the paperwork from the first call.
Does Medicare cover Spravato in New Jersey?
- Yes, Medicare covers Spravato for adults with treatment-resistant depression, meaning depression that hasn't responded to at least two antidepressants.
- Our Medicare patients usually pay $40 a treatment. Your own plan sets the details, and we check your cost before you start.
- Medicare Advantage: we accept every Medicare Advantage plan except UnitedHealthcare Medicare Advantage.
- NJ Medicaid as well? If you have both, call us. How we handle NJ Medicaid plans.
$0 to $40 a treatment
- NJ Medicaid: $0. Initial denials are common, and we’re incredibly persistent about appealing.
- Commercial insurance: up to $40 after Janssen’s SpravatoWithMe program, for patients who are eligible. Your own plan sets the details.
- We check before you commit. Insurance verification starts the moment you reach out.
From your Medicare card to your first treatment.
- You reach outSend the short form or call, with your Medicare or Medicare Advantage card handy.
- We check your planWe confirm how your plan covers Spravato and what you'd pay, before you commit to anything.
- Your evaluationUsually within one business day of your first call. No referral needed.
- We get the approvalIf your plan needs a prior authorization, we prepare it, submit it and follow it through.
Original Medicare or Medicare Advantage: what's the difference for Spravato?
The difference is who sets the rules. Original Medicare covers Spravato under Part B, the part that pays for care you receive in a doctor's office, because every dose is given and monitored in our office rather than picked up at a pharmacy. A Medicare Advantage plan is run by a private insurer under contract with Medicare, so it covers Spravato too but sets its own steps, which often include a prior authorization.
- Original Medicare (Parts A and B): Spravato is billed to Part B as an office treatment. If you also have a Medicare supplement (Medigap) plan, bring that card too.
- Medicare Advantage (Part C): your plan's own rules apply. We accept every Medicare Advantage plan except UnitedHealthcare Medicare Advantage.
- Either way: our Medicare patients usually pay $40 a treatment, and we confirm your cost before your first one.
What should you have ready when you call?
Have your cards and a rough medication history ready, and we'll do the rest. You don't need records in hand to start.
- Your Medicare card, plus your Medicare Advantage or Medigap card if you have one.
- The antidepressants you've tried, as best you remember them: the names, roughly how long you took each, and why you stopped. This is the information approvals ask for.
- Your current medications, including anything for blood pressure.
- Your doctors' names, if you have a psychiatrist or primary care doctor. A referral isn't needed.
Most people are evaluated within one business day of reaching out and are in a treatment chair within days.
What happens if Medicare Advantage denies Spravato?
If a Medicare Advantage plan denies Spravato, we keep going. Our evaluations are thorough, so we capture what a prior authorization usually asks for and first-time denials are rare: 95% of our requests are approved the first time. When one is denied, we always request a peer-to-peer review with the plan's doctor. If that fails, we always file a second-level appeal, and if that fails, we always take it to independent external review. In our most recent internal review, 34 of 36 denials were overturned.
Twice a week to start, so close matters.
Our offices are in Bridgewater, Morristown, Nutley and Hoboken, all on one phone number, (908) 450-7002. Someone else drives you home after each treatment.
A visit or two a week, not a pill every day.
Twice a week in the first month, once a week in the second, then weekly or every other week depending on how you're doing.
30 doses
Every day.
Side effectsEvery single day: sedation, dry mouth, sexual side effects, weight gain.
8 visits
Twice a week.
4 visits
Down to once a week.
2–4 visits a month
Down to once a week or every other week. Dashed: weeks you may or may not need.
Side effectsMostly gone by the end of each visit.
On Medicare? Find out your cost before you commit.
Send us your plan details and we'll check your Spravato coverage, usually before your evaluation.
Name, date of birth and insurer. We check your plan and call you back. No commitment.
Check my coverageRegister once, and our team starts your insurance check and reaches out to schedule your evaluation.
Request an evaluationWhat Medicare patients ask us about Spravato.
Does Medicare cover Spravato?
Yes. Medicare covers Spravato for adults with treatment-resistant depression. Our Medicare patients usually pay $40 a treatment, and we confirm your cost before you start.
How much does Spravato cost with Medicare?
Our Medicare patients usually pay $40 a treatment. Your plan sets the details, so we check yours before your first treatment.
Do you accept Medicare Advantage plans for Spravato?
Yes, every Medicare Advantage plan except UnitedHealthcare Medicare Advantage. If you have UnitedHealthcare Medicare Advantage, call us and we'll talk through your options.
Do I need a referral to get Spravato with Medicare?
No. You can call us directly. How to get Spravato in New Jersey.
Is there an age limit for Spravato?
Spravato is approved for adults, with no upper age limit. Many of our patients are on Medicare.