Does Medicare Cover Xanax? 

It’s normal to experience anxiety now and then, fretting over day-to-day concerns like health, finances, work and family. But if you suffer from high-level anxiety that does not go away and worsens over time, you may have an anxiety disorder. This condition can disrupt relationships, work performance and school success. Anxiety disorder is an overarching term that encompasses social and generalized anxiety disorders, phobias and panic disorders.

Treatment for anxiety disorders

If you are diagnosed with anxiety disorder, your doctor may refer you to psychotherapy, prescribe pharmaceutical drugs or suggest a combination of both approaches simultaneously. Though not a cure, medication may alleviate symptoms. Drugs often prescribed to manage the condition include antidepressants, beta-blockers and benzodiazepines.

Benzodiazepines are classified as Schedule IV drugs that work by slowing down your central nervous system to help you relax. Generic and brand-name pharmaceuticals within this drug class include diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Xanax). These drugs can reduce symptoms, but the U.S. Drug Enforcement Administration (DEA) warns of potential addiction and abuse.  

Medicare prescription drug plan

Medicare Part D is Medicare-approved prescription drug coverage that beneficiaries can purchase from private insurance companies during the Initial Enrollment Period. Medicare Advantage  with prescription drug coverage (MA-PD plans) incorporate Part D into coverage for Part A and Part B.

Beneficiaries who did not sign up for Part D when initially eligible can enroll during the annual Open Enrollment Period. The late enrollment penalty may be waived with if you have existing coverage under a drug plan comparable to Part D (creditable prescription drug coverage).

Drug costs

If your doctor prescribed Xanax, search for alprazolam, the generic version, in the plan’s formulary (list of covered drugs). Generic drugs typically cost less than brand name drugs. Factors influencing your drug cost include the assigned tier in the formulary, your drug benefit phase (initial, coverage gap or catastrophic) and the pharmacy you use (preferred, standard, in-network or out-of-network).

If applicable, you can apply to Social Security for the Extra Help program, which lowers drug costs for eligible Medicare beneficiaries. Eligibility is based on annual income, other financial resources and marital status.

Medicare mental health benefits

Medicare benefits include mental healthcare services for depression and anxiety. Part B may cover counseling or psychotherapy visits in a healthcare provider’s office or a hospital outpatient department. If a hospital or community health center offers partial hospitalization, you may qualify for intensive outpatient services during the day. Your outlay is the Part B deductible and 20% coinsurance.

Psychiatric Collaborative Care is an integrated behavioral healthcare program. A practitioner manages your condition through care planning, ongoing assessment, medication support, counseling and other treatments. If your doctor offers this model of care and you meet the qualifications, you are responsible for the Part B deductible and 20% of the charges Medicare has approved.

If admitted to a hospital, Part A covers the mental health services you receive as an inpatient. In that case, you pay the Part A deductible in addition to coinsurance for every day beyond 60 days. The lifetime benefit for a psychiatric inpatient admitted to a freestanding psychiatric hospital is 190 days.

Resources

Authoritative sources of information about anxiety disorder include the National Institute of Mental Health, the Anxiety & Depression Association of America (ADAA) and the National Alliance on Mental Illness (NAMI).