Ketamine is gaining ground in the mental health space, especially for people with depression that resists traditional treatments. You may have heard about its fast-acting effects or read stories about people finding relief where other therapies failed. However, one big question often comes up first: Does insurance actually cover ketamine therapy?
If you are a Medicare recipient or comparing Medicare to private options like Kaiser Permanente, coverage can get complicated. Some treatments are approved, others are not. Some must happen in a clinic, while others may put you at risk without proper supervision.
Let us walk you through the realities of insurance coverage for ketamine-based therapies and explain how Zeam Health & Wellness offers safe, supervised care right here in California.
What Is Ketamine Therapy and Why Does It Matter?
Ketamine is a well-known anesthetic that has been used for decades in operating rooms and emergency settings. But in recent years, mental health providers have begun using it off-label to help people with conditions like treatment-resistant depression, PTSD, anxiety, and suicidal ideation.
In mental health care, ketamine therapy comes in two main forms:
- Ketamine Infusions: Administered through an IV, this method delivers ketamine directly into the bloodstream under clinical supervision.
- Spravato (Esketamine): A nasal spray version of ketamine’s S-enantiomer, FDA-approved for treatment-resistant depression and major depressive disorder with suicidal thoughts.
Although both treatments use similar compounds, Spravato has official FDA approval, while ketamine infusions remain off-label for psychiatric care. That distinction makes a big difference when it comes to insurance.
What Is Ketamine Therapy and Why Does It Matter?
Ketamine is a well-known anesthetic that has been used for decades in operating rooms and emergency settings. But in recent years, mental health providers have begun using it off-label to help people with conditions like treatment-resistant depression, PTSD, anxiety, and suicidal ideation.
In mental health care, ketamine therapy comes in two main forms:
- Ketamine Infusions: Administered through an IV, this method delivers ketamine directly into the bloodstream under clinical supervision.
- Spravato (Esketamine): A nasal spray version of ketamine’s S-enantiomer, FDA-approved for treatment-resistant depression and major depressive disorder with suicidal thoughts.
Although both treatments use similar compounds, Spravato has official FDA approval, while ketamine infusions remain off-label for psychiatric care. That distinction makes a big difference when it comes to insurance.
Why Medicare Does Not Cover Ketamine Infusions
Medicare typically does not cover ketamine infusions for mental health treatment. The reason is regulatory, not clinical.
The FDA only approves ketamine as a general anesthetic. That means Medicare Part B will usually deny claims for infusions used to treat depression or anxiety because they are considered off-label.
Off-label use is legal and often beneficial when prescribed by a licensed professional. However, Medicare only makes exceptions for off-label drugs that are supported by certain medical compendia, such as the DRUGDEX Information System or the American Hospital Formulary Service Drug Information. Currently, neither of those sources endorses ketamine infusions for mental health.
The lack of endorsement also blocks Medicare from recognizing this treatment as “medically necessary,” which is another key condition for coverage.
Even when ketamine is administered by a licensed provider in a safe setting, Medicare beneficiaries are likely to pay out of pocket if the treatment is for depression, PTSD, or any other psychiatric condition.
Spravato: A Medicare-Covered Alternative for Treatment-Resistant Depression
Spravato, a nasal spray that contains esketamine, is a different story.
Approved by the FDA in 2019, Spravato is specifically designed to treat adults with depression who have not responded to at least two other antidepressants. It also carries approval for use in patients with major depressive disorder and active suicidal ideation in combination with oral antidepressants.
Because of its approval status, Spravato is eligible for coverage under Medicare Part B as long as it is administered in a certified facility and the patient meets all clinical criteria.
Spravato is not a take-home medication. It must be given in a controlled medical setting as part of the Risk Evaluation and Mitigation Strategy (REMS) program. Patients self-administer the nasal spray under supervision and are monitored for at least two hours afterward.
Why the supervision? Esketamine can cause dissociation, sedation, and blood pressure spikes. That is why the REMS program is required to prevent misuse and ensure patient safety.
Once the annual Part B deductible is met ($257 in 2025), Medicare covers 80% of the treatment cost, with the patient responsible for the remaining 20% unless they have supplemental coverage.
Private Insurance Coverage for Ketamine Therapy
If you are not on Medicare, your insurance experience may vary widely.
Some private insurers, including Kaiser Permanente, cover ketamine infusions under select circumstances. This usually involves:
- Documented history of treatment-resistant depression
- Failure to improve after trying multiple antidepressants
- Preauthorization from the insurer
- Treatment in an approved medical facility
Spravato tends to be more widely covered than IV ketamine because it is FDA-approved and comes with a clear protocol for administration and monitoring.
However, every insurance plan is different. Even if your plan includes behavioral health benefits, you should verify coverage details before scheduling treatment. Ask about prior authorization, coverage limits, co-pays, and which providers are in-network.
The FDA’s Warning About Compounded Ketamine Products
As demand for ketamine therapy grows, so does the market for compounded ketamine products, especially oral, sublingual, or at-home nasal sprays offered through telemedicine platforms.
The FDA issued a safety warning in October 2023 about these formulations. According to the agency, compounded ketamine is not FDA-approved for any psychiatric use, and its safety, dosing, and quality have not been validated through clinical trials.
Compounded ketamine carries a higher risk of:
- Respiratory depression
- Disorientation or dissociation
- Blood pressure instability
- Psychiatric complications or worsening symptoms
- Abuse, addiction, and improper dosing
If you are considering ketamine therapy, avoid at-home or unregulated options. These products are neither safe nor covered by insurance.
What to Know Before You Begin Ketamine-Based Therapy
At Zeam Health & Wellness, we believe mental health treatments should be science-backed, accessible, and safe. That is why we provide clinically supervised, FDA-compliant services, including Spravato administration and ketamine-assisted psychotherapy.
We do not offer compounded or at-home ketamine products. Instead, our clinics in Folsom, Roseville, and Sacramento follow evidence-based practices and state licensing standards.
Before starting treatment, we encourage you to:
- Check with your insurance provider about coverage eligibility
- Ask about deductibles, coinsurance, and prior authorization steps
- Confirm whether your treatment meets FDA or REMS criteria
- Discuss potential risks and benefits with a licensed mental health provider
Our team helps patients understand their insurance benefits and outlines a personalized care plan that aligns with both clinical goals and financial realities.
Take the Next Step Toward Clarity and Care
If you feel stuck with treatment-resistant depression or you want to explore alternatives to standard antidepressants, ketamine therapy may offer a path forward. But you need the right information and the right provider to move confidently.
Our clinics in Folsom, Roseville, and Sacramento are fully equipped to deliver safe, evidence-based care with full transparency around costs, coverage, and outcomes. Contact us to schedule a consultation.
