Common Medicare Terms

Mental illness has been getting more attention publicly in an effort to get help for those suffering with depression, anxiety, or other disorders, but there are still misconceptions when it comes to older adults. According to the National Council on Aging, one in four older adults experience a mental disorder, such as depression, anxiety, or dementia. While it is true that Medicare recipients may be more vulnerable to feelings of isolation or loneliness, depression is a medical condition that interferes with daily life and normal functioning. Unfortunately, some people assume that mental health issues are a normal part of aging and do not seek help.

Depression can have many symptoms, including but not limited to:

  • Feelings of hopelessness
  • Loss of interest in hobbies or activities
  • Trouble sleeping
  • Persistent sadness, anxiety, or pessimism
  • Difficulty concentrating or making decisions
  • Weight and appetite changes
  • Thoughts of suicide

If you or a loved one exhibits these signs, it is important to call your doctor and make an appointment. Don’t suffer in silence. Your physician can provide different treatment options, including counseling and medication, that can improve your overall health and quality of life. If your physician determines you have a medical need for antidepressants, Medicare coverage may be able to help cover the costs.

Medicare Coverage for Antidepressants

Medicare recipients have the option of getting their Part A and Part B benefits through Original Medicare or Medicare Advantage (Part C), but it is Part D (optional prescription drug coverage) that will help you pay for prescription medications, including antidepressants. Let’s take a look at the Medicare options and find out how Medicare can help pay for these medications:

Original Medicare – Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance) and is administered by the federal government. Most people receive premium free Part A because they have paid taxes for a certain period of time while working. Part B will generally have a monthly premium and annual deductible. Even though Original Medicare covers the costs of many services and supplies, some people choose to purchase supplemental insurance, or Medigap, to help pay some of the out-of-pocket expenses, including deductibles, coinsurance, or copayments. Unfortunately, Part A, Part B, and Medigap do NOT include prescription drug coverage.

If you have Original Medicare, you may consider enrolling in a stand-alone Prescription Drug Plan (PDP). Prescription Drug Plans are sold by private insurance companies approved by Medicare. If you do not enroll in a PDP when you are first eligible for Medicare and decide to enroll at a later date, you may incur a late enrollment penalty. Each PDP will offer different costs and have its own formulary, or list of covered drugs, so compare plans carefully before you enroll. If you are already taking a specific antidepressant medication, you can check the formularies of those plans you are considering to check coverage and cost.

Medicare Advantage (Part C) – Medicare Advantage (MA) plans administer your Part A and Part B benefits through a private insurance company that contracts with Medicare. MA plans are required to provide at least the same benefits as Original Medicare, but many offer additional coverage, including dental, vision, and prescription drug coverage. Medicare Advantage plans with prescription drug coverage (MA-PDs) may have different formularies and costs and may include a specific network of pharmacies you need to visit in order to be covered.

While most prescription drug coverage will help pay for the cost of antidepressants, every PDP or MA-PD may have a different “tier” of pricing based on generic, brand-name, or mail order prescriptions. If you meet certain low income criteria, you may qualify for Extra Help paying for your prescription drugs.