What your plan actually covers

Original Medicare Part B covers Spravato (esketamine) when administered in a REMS-certified site for treatment-resistant depression. Medicare Advantage (Part C) plans must cover it at least as well as original Medicare but often add step-therapy requirements. Off-label IV ketamine is generally not reimbursed by Medicare.

Spravato coverage under Medicaid varies dramatically by state. Most state Medicaid programs now cover Spravato for treatment-resistant depression, but with strict step-therapy (usually requiring 2-4 prior antidepressant trials and often augmentation attempts). A growing number of states also reimburse for ketamine-assisted psychotherapy billed under psychiatric and nursing codes.

BCBS is a federation of 33+ independent plans. Nearly all of them cover Spravato for treatment-resistant depression; rules vary. A handful - notably BCBS of Massachusetts, Anthem BCBS (CA, CO, CT, GA, IN, KY, ME, MO, NV, NH, NY, OH, VA, WI) and Highmark - cover ketamine infusions under specific medical-necessity criteria. Others reimburse only the professional component while you pay for the drug.

Aetna covers Spravato for TRD with prior authorization and a documented two-trial history. Does not cover IV ketamine except in a handful of grandfathered fully-insured commercial plans. Aetna Better Health (Medicaid managed) covers Spravato in most states.

Cigna covers Spravato under its behavioral health benefits. Prior authorization required, with a two-trial step-therapy requirement. Cigna historically had one of the more generous ketamine infusion policies but narrowed it in 2024; today only specific plan designs cover IV ketamine for TRD.

United covers Spravato for TRD through Optum Behavioral Health. Prior authorization is required and Optum runs a concurrent review. IV ketamine is generally not covered except where your employer has added it as a supplemental benefit.

Kaiser offers Spravato at its own REMS-certified clinics in the regions where Kaiser operates (CA, CO, GA, HI, MD, OR, VA, WA, plus DC). You must be a Kaiser member and receive a referral from a Kaiser psychiatrist. External ketamine clinics are not covered.

Humana's commercial footprint is small; its Medicare Advantage program is large. Humana MA plans cover Spravato under Part B / medical benefit, with standard prior authorization and step therapy.

Tricare covers Spravato for TRD under prior authorization. IV ketamine is covered in narrow circumstances for treatment-resistant depression or chronic pain at MTF (military treatment facility) or specifically contracted community sites.

Anthem (an Elevance Health subsidiary) operates BCBS plans in 14 states. Spravato is covered with prior auth. IV ketamine for TRD is covered under Anthem Medical Policy BEH.00014 in most Anthem states - one of the more generous commercial ketamine policies in the country.

Optum Behavioral Health administers mental health benefits for UnitedHealthcare, plus a number of self-insured employer groups. Same Spravato rules as UnitedHealthcare. Some Optum-managed plans reimburse for ketamine-assisted psychotherapy (KAP) when billed under psychotherapy CPT codes.

The IRS has ruled that medically-supervised ketamine treatment (infusion, IM or oral) for a diagnosed condition qualifies as an eligible medical expense - so you can pay with pre-tax HSA or FSA dollars. Spravato copays and coinsurance are obviously eligible. Psilocybin services are not eligible because psilocybin is federally illegal regardless of state program status.

For services not covered by insurance - most notably psilocybin services in Oregon and Colorado, plus most IV ketamine - you pay out of pocket. Many clinics offer discounted bundled pricing for a six-session series. A growing number partner with CareCredit or Advance Care for third-party financing.