If you refer patients with stubborn depression, here is a pair of numbers to hold against your own referral list: in our general-population survey of 443 Midwest adults, commercial insurance drew 39 percent and Medicaid 37 percent. Not a commercial landslide. A near tie.
We commissioned the survey this summer to understand how people decide on newer depression treatments, specifically ketamine and esketamine therapy. The payer question was almost an afterthought. For anyone who sends patients onward, it became among the most consequential results we have.
These results are final; the panel has completed validation.
What respondents reported
Respondents could name more than one type of coverage. The results:
- Employer or individual commercial plans: 39 percent
- Medicaid, via state programs or managed care: 37 percent
- Medicare, original or Advantage: 23 percent
- No coverage at all: 9 percent
- TRICARE: 5 percent
- Prefer not to say: 2 percent
A two-point lead is not a meaningful difference, and we would not stake much on the order holding in a larger sample. The practical finding is near parity. Public and private coverage are roughly even among the people who answered, and Medicare adds a substantial group despite a sample capped at age 64.
Why a referrer should care
Three other results from the same survey make the payer mix matter more than it otherwise might.
Coverage is the first filter. Allowed only two provider traits, our respondents chose insurance 85 percent of the time; proximity trailed at 43 percent, FDA approval reached 27 percent, with speed three points lower.
Coverage often decides whether treatment happens at all. Our respondents said so plainly. For 65 percent, whether to try ketamine or esketamine would hinge largely or entirely on insurance.
You are the person they listen to. Seventy-four percent told us their personal doctor's endorsement would make them willing to go ahead. Just 2 percent said an ad would. And 56 percent named a primary doctor as their opening move.
Taken together, these describe a patient who trusts you to point the way, filters every option through coverage, and is about as likely to hold Medicaid as a commercial plan. A referral that does not match the patient's coverage is, for many of them, a referral that goes nowhere.
The quiet failure mode
Consider what happens when a physician refers a Medicaid patient to a site that does not participate with their managed care plan. The patient calls, learns the site cannot see them, and is left to start over. Some will call the plan, find another site, and return. Many will not. Depression itself erodes the energy needed to recover from a dead end.
None of this shows up in your chart as a failed referral. It shows up as a patient who is still struggling at the next visit, or who does not come back.
Why the parity is plausible
We did not ask respondents why they hold the coverage they do, so this is context rather than finding. Several states in our ten-state region have expanded Medicaid eligibility for working-age adults in recent years. Our sample excludes adults over 64, which lowers the Medicare share by age. And the Pollfish panel reaches a broad slice of the public through mobile apps, not a clinic waiting room. The result reflects an ordinary adult population, which is closer to a primary care panel than a specialty practice's intake list.
What esketamine coverage usually involves
Spravato, the brand of esketamine, is labeled for grown patients whose depression has resisted treatment, and only REMS-enrolled sites may dispense it, after which the patient stays under watch for at least a couple of hours and avoids driving until the next day, after sleep. A patient-facing summary of esketamine costs and insurance coverage from Brain Recovery Centers can go out with the referral. Payers that cover it, commercial and Medicaid alike, commonly require prior authorization, often including documentation of prior antidepressant trials. Specific criteria vary by plan and state.
Payers typically treat IV ketamine and home-use ketamine, both off-label for depression, quite differently. Patients often conflate the two, so it helps to be explicit about which you are recommending.
Five practical adjustments
- Know which nearby certified sites accept which Medicaid managed care plans. A short, current list saves every patient a round of phone calls.
- Ask about coverage before you refer, not after. A one-line question at the end of the visit, "What plan are you on?", lets your staff route the referral correctly.
- Document with prior authorization in mind. Medication names, doses, durations, and reasons for stopping are what reviewers typically look for.
- Mention transportation. Medicaid plans frequently include rides to medical visits, and the no-driving rule makes that relevant.
- Give patients the words. Awareness is low. In our poll, Spravato was an unknown word to 73 percent. A patient who does not know the name cannot call and ask about it.
A note on the uninsured and TRICARE groups
The smaller groups deserve a thought as well. Roughly one respondent in eleven reported no coverage at all, and some may be eligible for Medicaid without knowing it. A prompt to check eligibility can be the most useful referral you make. The TRICARE group is small in the sample, but often has specific referral requirements through a primary care manager, and those can stall care if missed.
What this does and does not show
This is whole-sample market research. It shows the overall coverage mix among respondents. This article reports the whole sample only; it does not describe how Medicaid members or any other group answered other questions. It is not clinical evidence and does not speak to efficacy or suitability for any individual patient. Those remain your clinical judgment.
For patients in crisis, put 988 on every handout, since it reaches Suicide and Crisis Lifeline counselors by voice or text at any hour. A patient who is waiting on a prior authorization still needs somewhere to turn tonight.
Methodology
For referrers checking the source: Pollfish survey 395586438, consumer panel, fieldwork ending June 23, 2026, 443 completes from working-age adults in Minnesota, Wisconsin, Missouri, Iowa, Indiana, Nebraska, Illinois, Oklahoma, Kansas and Ohio. Coverage allowed several answers per person. Whole-sample figures, final and validated. The publisher commissioned and funded the study and has a commercial interest in depression care marketing.