If you have Original Medicare (Part A and Part B), there is generally no coverage for prescription medications such as Seroquel, unless you are also enrolled in a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. Here’s what you should know about Medicare coverage of Seroquel.
When does Medicare cover Seroquel?
Seroquel, and its generic formulation quetiapine fumarate, belongs to a class of medications known as atypical antipsychotics. It is used to treat schizophrenia, bipolar disorder, and certain types of depression.
Under Original Medicare Part A and Part B, Seroquel is usually only covered if you receive the medication while you are an inpatient in a hospital or other facility during a covered stay. If you take Seroquel at home, Original Medicare usually doesn’t cover it.
However, if you enroll in a Medicare Part D Prescription Drug Plan to go alongside your Original Medicare coverage, your plan will most likely pay some or all of your costs for Seroquel. This is because Seroquel belongs to a protected class of medications (antipsychotics), which means that all Medicare Part D Prescription Drug Plans must cover all FDA-approved, or almost all, medications in the antipsychotic class.
What are my options for Medicare Part D coverage for Seroquel?
You can get Medicare Part D coverage for prescription drugs like Seroquel in one of two ways:
- You can enroll in a stand-alone Medicare Part D Prescription Drug Plan, or
- You can enroll in a Medicare Advantage plan with coverage for prescription drugs included, sometimes called MAPD.
Stand-alone plans can only be combined with Original Medicare and certain other types of Medicare health plans. If you have a Medicare Advantage Health Maintenance Organization (HMO) plan or Preferred Provider Organization (PPO) plan and want Part D prescription drug coverage, be sure to select an MAPD plan.
Many people under a doctor’s care for depression or another long-term condition such as schizophrenia or bipolar disorder may find that a Medicare Advantage Prescription Drug plan may help with their out-of-pocket health care costs. Medicare Advantage plans are an alternate way to get all your Medicare benefits in one easy-to-manage plan. By law, they must provide at least the same coverage as Original Medicare, except for hospice care, which is still covered under Part A. Many MAPDs offer extra perks, such as benefits for routine vision and dental care, and even wellness programs and discounted gym memberships in some cases.
Note that Medicare Advantage and Medicare Part D Prescription Drug Plans are offered by private insurance companies contracted with Medicare. Each plan sets its own benefits and premiums, and not all plan types may be available in all locations. In addition, plan benefits, premiums, deductibles, copayments, and/or coinsurance amounts may vary depending on where you live and the plan you select. You must continue to pay your Part B premium if you enroll in a Medicare Advantage plan, plus any additional premium required by your plan.
If you want Medicare Part D prescription drug coverage for Seroquel and other medications, it’s important to enroll as soon as you are eligible. If you wait, you may have to pay a late-enrollment penalty for as long as you have coverage.