Is TMS, ECT, and Spravato for depression covered by insurance?
Treatments for depression that hasn’t improved with medication and therapy. Here’s how each kind of plan usually handles it.
- Employer or MarketplaceCovered with conditions
Usually covered with prior authorization when depression hasn’t improved with other treatment.
More details
Plans usually require a diagnosis of major depression and several antidepressant trials (often with therapy) before approving TMS. ECT is widely covered. Spravato (esketamine) is covered with at certified clinics. IV ketamine for depression is off-label and usually not covered.
Cost: Your mental health cost sharing; a course of TMS is many sessions.
- Original MedicareCovered with conditions
Yes, with conditions: Medicare covers ECT, and TMS under regional rules, for depression that hasn’t responded to treatment.
More details
Medicare’s regional contractors set the TMS criteria, which require documented treatment-resistant depression. Spravato is covered with ; whether it’s billed under or your drug plan depends on the setting and plan. IV ketamine for depression isn’t covered.
Cost: 20% after the Part B deductible for ECT and TMS.
- Medicare AdvantageCovered with conditions
Yes, with conditions: Medicare covers ECT, and TMS under regional rules, for depression that hasn’t responded to treatment.
More details
Medicare’s regional contractors set the TMS criteria, which require documented treatment-resistant depression. Spravato is covered with ; whether it’s billed under or your drug plan depends on the setting and plan. IV ketamine for depression isn’t covered. Medicare Advantage plans must cover this too, but set their own copays and often require in-network providers and prior authorization.
Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.
- MedicaidCovered with conditions
Yes, with prior authorization: Medicaid covers ECT and Spravato, and many states cover TMS.
More details
Spravato is covered like other prescription drugs, with and treatment at a certified center. ECT is covered as a hospital or outpatient procedure. Many states cover TMS after you’ve tried medications, with prior authorization.
What usually has to be true
- Prior authorization with a record of earlier treatments is standard.
Good to know
- Mental health parity rules mean plans can’t make approval for these harder than for comparable medical treatments.
Related
- Psychiatrist · Psychiatric evaluation and medication management.
- Therapy & counseling · Outpatient psychotherapy with a psychologist, LCSW, LPC, or MFT.
- Inpatient mental health care · Psychiatric hospitalization, residential, and intensive programs.
Sources
Typical rules for 2026 plans, checked against these sources on October 20, 2026. Your plan’s own documents decide.
- 1Mental health and substance use disorder coverage
HealthCare.gov
Marketplace plans cover behavioral health treatment such as psychotherapy and counseling, inpatient mental and behavioral health services, and substance use disorder treatment.
- 2Mental Health and Substance Use Disorder Parity
U.S. Department of Labor
For plans subject to parity, covered mental health benefits generally cannot face more restrictive financial requirements or treatment limitations than comparable medical benefits.
- 3Outpatient mental health care
Medicare.gov
Part B covers outpatient mental health services. After the deductible, patients generally pay 20% of the approved amount, with possible hospital outpatient charges.
- 4Compare Original Medicare and Medicare Advantage
Medicare.gov
Medicare Advantage plans cover everything Original Medicare covers (except hospice, which Original Medicare continues to pay), usually use provider networks, often require referrals or prior authorization, and may offer extra benefits such as dental, vision, and hearing.
- 5Mandatory and optional Medicaid benefits
Medicaid.gov
States must cover mandatory benefits such as inpatient and outpatient hospital care, physician services, laboratory and X-ray services, home health, and nursing facility care; many other benefits, including adult dental, vision, and prescription drugs coverage details, are state options.
General information about how coverage usually works, not a decision about your plan. Your plan documents and insurer have the final word.