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If you have Original Medicare (Part A and Part B), treatment with Remeron is generally not covered, unless you are also enrolled in a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. If you are under a doctor’s care for depression and want help paying for your Remeron and other prescription medications, here’s what you should know about Medicare Part D coverage for prescription drugs.
When does Medicare cover Remeron?
Remeron, the brand name medication of the generic drug mirtazapine, is an anti-depressant that works by increasing different types of brain activity to help you maintain mental balance according to the U.S. National Library of Medicine. If your doctor prescribes Remeron for use at home, there is generally no Medicare coverage under Part A or Part B. Medicare Part A may cover Remeron if you are given it while in the hospital as an inpatient or other inpatient facilities during a covered stay.
If you enroll in a Medicare Part D Prescription Drug Plan, some or all of the costs associated with Remeron treatment at home may be covered. Private insurance companies contracted with Medicare that offer Medicare Part D coverage for prescription drugs use a formulary to determine benefits for various medications. A formulary is simply a list of approved prescription drugs, how much the plan pays for each, and any special requirements for filling your prescription, such as prior authorization from your plan.
It’s important to remember that a plan may change its formulary at any time, but you will be notified in writing before any changes take effect.
Do Medicare Advantage plans cover Remeron?
Many Medicare Advantage plans do include coverage for prescription drugs; these plans are referred to as Medicare Advantage Prescription Drug Plans and they are most often Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs)*. In many cases, people being treated for depression or other chronic health conditions find that Medicare Advantage Prescription Drug plans are a convenient way to get all their Medicare benefits in one plan.
By law, Medicare Advantage plans must cover everything that Original Medicare covers, except for hospice care, which is still provided under Part A. In addition to prescription drug coverage, many Medicare Advantage plans also include benefits for other services such as routine vision, dental, and hearing care, and even wellness programs.
Medicare Advantage plans and Medicare Advantage Part D Prescription Drug Plans are offered by private insurance companies contracted with Medicare; not all plan types may be available in all areas. Plan premiums and benefits may vary depending on where you live. You must continue to pay your Part B premium if you enroll in a Medicare Advantage plan, plus any additional premiums required by your plan.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.