Does Medicare Cover Celexa?
This article was updated on: 09/10/2018
Celexa (generic name: citalopram) is a type of antidepressant medication known as a selective serotonin reuptake inhibitor (SSRI), according to the National Institutes of Health’s Medline Plus website. Generally, Original Medicare (Part A and Part B) include limited coverage of prescription drugs, and only in specific situations.
Does Medicare ever cover Celexa?
There are four parts to the Medicare program: Part A (hospital insurance) and Part B (medical insurance) make up Original Medicare; Part C is the Medicare Advantage program; and Part D provides coverage for prescription drugs. Under Part A, if you are hospitalized as an inpatient, and your doctor prescribes Celexa as part of your treatment, Medicare may cover your medication. However, outside that situation, Original Medicare generally doesn’t cover Celexa or other prescription drugs you take at home.
That’s why you might want to explore Medicare plan options that include prescription drug coverage for Celexa. Available from private, Medicare-approved insurance companies, these types of plan options offer prescription drug benefits:
- A stand-alone Medicare Part D Prescription Drug Plan that can work alongside your Original Medicare benefits
- A Medicare Advantage Prescription Drug plan to cover all your Medicare benefits. Medicare Advantage plans include all your Original Medicare benefits (besides hospice care, which Part A covers). Not every Medicare Advantage plans cover prescription drugs, but most of them do – and many of them also include additional benefits, like routine dental care. If you enroll in this type of plan, you’ll need to pay any premium the plan charges, along with your Medicare Part B premium.
Every Medicare plan that includes prescription drug coverage uses a formulary, or list of covered medications, to determine how they pay benefits. Citalopram (the generic form of Celexa) belongs to one of six protected classes of medications, which include antidepressants, anti-cancer drugs, and drugs to treat HIV/AIDS, among others. This means that all Medicare plans offering prescription drug coverage must include a range of antidepressants in their formularies. So, if you enroll in a Medicare plan with prescription drug benefits, your citalopram treatment is likely covered by your plan. Even if your plan changes its formulary benefits from time to time (and you will receive notice from your plan when necessary), it must still cover medications in protected classes.
Who is eligible for Medicare prescription drug coverage?
Anyone who is eligible for the Medicare program can enroll in a stand-alone Medicare Part D Prescription Drug Plan. In fact, if you don’t enroll in this coverage when you are first eligible for Medicare, and don’t have creditable prescription drug coverage from another source, you may have to pay a late-enrollment penalty with your monthly premium when you do enroll. This penalty applies for as long as you have coverage. Prescription drug coverage is optional, but the penalty may apply if you decide to sign up for it after your Medicare Initial Enrollment Period has passed.
To be eligible to enroll in a stand-alone Medicare Part D Prescription Drug Plan:
- You must be enrolled in Part A, Part B, or both (Original Medicare)
- You must live in the plan’s service area
- You must pay any required monthly premiums associated with your plan
You may be eligible for a Medicare Advantage Prescription Drug plan, unless you have End-Stage Renal Disease (ESRD). There are exceptions, so ask the plan you’re interested in about your eligibility. Also, you might be eligible for a type of Medicare Advantage plan called a Special Needs Plan.
Other than that, the eligibility requirements for Medicare Advantage are the same as for Medicare Prescription Drug Plans except that you must be enrolled in both Medicare Part A and Part B.
What else should I know about Medicare prescription drug coverage for Celexa or other medications?
Each stand-alone Medicare Part D Prescription Drug Plan and Medicare Advantage plan may have an annual deductible and require coinsurance amounts or copayments when you access benefits. Plan availability varies, so you might want to click Find Plans on this page to compare plans where you live.
If you have questions about Medicare coverage options, I’m available to help. You can request information via email or schedule a phone call at your convenience by clicking one of the links below. To see a list of plans in your area that you may qualify for, click the Compare Plans or Find Plans button.