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Does Medicare Cover Zoloft?

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Doctors sometimes prescribe Zoloft to treat symptoms like anxiety and depression. A Medicare Part D Prescription Drug Plan might cover Zoloft.

What is Zoloft?

Zoloft is a prescription drug classified as an antidepressant. The Zoloft generic equivalent is sertraline, according to the Food and Drug Administration.

What is Zoloft used for?

The National Institutes of Health publication Medline Plus lists several conditions Zoloft (generic name sertraline) might be used to treat. Besides depression, it may also treat:

  • Panic attacks
  • Obsessive-compulsive disorder (OCD)
  • Social anxiety disorder
  • Post-traumatic stress disorder (PTSD)
  • Certain premenstrual symptoms

This may not be a complete list.

According to Medline Plus, the medication works by increasing the natural serotonin levels in your brain to help maintain behavioral balance.

Is Zoloft covered under Original Medicare?

When it comes to Zoloft coverage under Original Medicare (Part A and Part B), it’s not generally covered except in specific situations.

Original Medicare coverage of prescription drugs is limited. Under Medicare Part A, you’ll typically be covered for prescription drugs you get as part of an inpatient hospital or skilled nursing facility stay. Under Medicare Part B, you may be covered for some medications administered to you as an outpatient, such as in a doctor’s office or outpatient hospital setting.

Is Zoloft covered under Medicare Part D?

If you want Medicare coverage for Zoloft or any medications, consider enrolling in a Medicare Prescription Drug Plan. As a beneficiary, you can get a stand-alone Medicare Part D Prescription Drug Plan if you have Original Medicare Part A and/or Part B. Alternatively, you can enroll in a Medicare Advantage Prescription Drug plan, which provides both your Original Medicare health benefits and your prescription drug benefits under a single plan. Please note that hospice benefits are still covered under Part A instead of directly through your Medicare Advantage plan.

Medicare Prescription Drug Plans must cover antidepressant medications. Zoloft is an antidepressant, but a plan doesn’t specifically have to cover this particular medication, as long as it covers most antidepressants.

Zoloft and/or the Zoloft generic equivalent, sertraline, may be covered under a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan. You’ll need to check the prescription medication formulary for the plan you’re considering. A formulary is a list of all the medications that are covered by that plan, and this list may vary from plan to plan. Costs may also vary by plan. The formulary may change at any time. You will receive notice from your plan when necessary.

As a Medicare beneficiary, you may want to review your prescription drug coverage every year. Take the time to shop around and compare plans in your area; even if your plan doesn’t make any formulary or cost changes, you may be able to find a better deal elsewhere. If you’d like understanding how Medicare Prescription Drug Plans work, just let me know. To talk by phone or email, click on the “Get Quotes” button on this page to set up a phone appointment or have me contact you by email.

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