Medicare covers a variety of generic and brand-name prescription drugs, including antidepressants, to treat mental health conditions.

Not every plan will cover every possible antidepressant, but because antidepressants are a protected class, most antidepressants are covered by all Part D plans.

Your cost for antidepressants will depend on several factors. The cost of generic antidepressants, for example, is significantly less than the brand name.

The commonly prescribed antidepressant Zoloft can cost as much as $325 for the brand name. The generic form of Zoloft, sertraline, on the other hand, costs between $7 and $30, even without insurance coverage.

Every plan structures this a little differently, and your costs often depend on your premium and deductible.

Original Medicare (Parts A and B), Medicare Advantage (Part C), and prescription drug (Part D) plans cover different aspects of mental health treatment.

The part of Medicare that covers antidepressants depends on where you receive the medication.

Part A is hospital insurance. It covers inpatient mental health services at a general or psychiatric hospital, including the administration of antidepressant medications and other drugs during your stay.

Most people do not have a monthly premium for Part A. If you aren’t eligible for premium-free Part A, you’ll pay $278 or $505 each month.

Here are the basic costs for an inpatient hospital stay in 2024:

  • $1,632 deductible for each benefit period
  • $0 coinsurance for days 1 to 60 of treatment after you pay your deductible
  • $408 coinsurance per day for days 61 to 90 of treatment
  • $816 coinsurance per day for days 91 to 150 of treatment while using your 60 lifetime reserve days
  • 100% of the treatment costs for days 151+

Part A covers up to 190 days of inpatient mental health services in a freestanding psychiatric hospital during your lifetime.

This limit doesn’t apply to mental health services you receive in a psychiatric unit within an acute care or critical access hospital.

Part B is medical insurance. It covers partial hospitalization mental health services, including the administration of antidepressant medications and other drugs at the treatment facility.

In 2024, most people will pay a monthly premium of $174.70. Your premium may be higher depending on your income.

After you pay a $240 deductible, you’ll generally pay 20% of all Medicare-approved costs for covered services. This is known as “cost-sharing.”

Part C is an alternative to Original Medicare that must cover the same basic services, including inpatient and outpatient mental health care.

Many Part C plans also include Part D coverage for prescription drugs. This is known as a Medicare Advantage prescription drug plan (MA-DP).

Each Part C plan sets its own cost and coverage amounts. The premiums, deductibles, copayments, and coinsurance amounts you’ll pay depend on your specific plan.

Staying in network — which means getting care from a list of approved healthcare professionals and facilities, including filling your prescriptions at certain pharmacies — typically costs less than going out of network.

Part C plans limit what you’ll pay out of pocket each year for covered services. Once you reach the plan’s out-of-pocket maximum, it will pay 100% of all approved costs for the rest of the calendar year.

Part D is prescription drug coverage. You can purchase a stand-alone prescription drug plan (PDP) as an add-on to Original Medicare or enroll in an MA-DP.

Each Part D plan sets its own cost and coverage amounts. The amount of coverage each plan provides depends on its formulary and tier system.

A formulary is a list of medications the plan covers. Those medications are then divided into groups or tiers, typically based on cost. For example:

  • Tier 1 ($): generics
  • Tier 2 ($$): preferred brand names
  • Tier 3 ($$$): nonpreferred brand names
  • Tier 4 ($$$$): speciality

According to the nonprofit KFF, in 2023, a larger share of MA-PD enrollees paid $0 for standard or preferred generic medications than PDP enrollees.

For preferred brands:

  • 65% of MA-PD enrollees and 21% of PDP enrollees faced a $45 to $47 copayment, which is the maximum amount permitted by the Centers for Medicare & Medicaid Services (CMS)
  • Fewer than 1% of MA-PD enrollees and 40% of PDP enrollees faced a coinsurance of up to 25%

For nonpreferred drugs:

  • 91% of MA-PD enrollees are charged copayments, while almost all PDP enrollees are charged coinsurance
  • 53% of MA-PD enrollees are charged $100 for nonpreferred drugs, which is the CMS maximum
  • 50% of PDP enrollees are charged 40% to 49% coinsurance for nonpreferred drugs
  • 24% of PDP enrollees are charged 50% coinsurance, which is the CMS maximum

For specialty drugs:

  • 76% of MA-PD enrollees and 14% of PDP enrollees faced a 33% coinsurance, which is the CMS maximum
  • 3% of MA-PD enrollees and 76% of PDP enrollees faced a 25% coinsurance, which is the CMS minimum

Although all prescription drug plans are required to cover antidepressant medications, your plan may not cover the exact medication you or your healthcare professional request. However, a similar antidepressant should be available.

If a suitable replacement is unavailable, or your healthcare professional believes a specific antidepressant is your best option for treatment, you can file for an exception with Medicare.

You can also file for an exception if your specific antidepressant is in a more expensive tier than similar but unsuitable drugs, as identified by your prescribing physician. You may be eligible for a lower copayment.

If you don’t qualify for a formulary exception, you’ll have to pay the full out-of-pocket price for your specific antidepressant or switch to a Medicare-approved alternative.

Your plan may also have rules about where you fill your prescriptions. Your plan’s network might offer a discount for using a preferred pharmacy or mail-order program.

Part A covers inpatient administration of antidepressant drugs during a covered hospital stay. Part B covers outpatient administration during partial hospitalization.

Part C covers inpatient and outpatient administration during approved mental health services, as well as prescription drug coverage. If you have Original Medicare, you can purchase a Part D plan for drug coverage.

Your out-of-pocket costs depend on what part of Medicare you have, whether you’re accessing inpatient or outpatient mental health services, and whether you receive brand-name or generic antidepressant drugs.