From our survey

Only 14 percent said insurance would not matter to them

Here is a number from our survey worth sitting with: only 14 percent. That is the share of people in our survey who said insurance coverage would make no difference to whether they tried a new depression treatment. For everyone else, coverage mattered, and for most of them it mattered a lot.

Our June 2026 poll heard from 443 adults in ten Midwest states, Missouri among them, and its figures are final, validated by Pollfish. This piece reads the insurance findings from St. Charles, where the question of who pays is rarely far from the question of whether to start.

The full gradient

We asked how much insurance coverage would factor into the decision to try ketamine or esketamine therapy. Respondents answered:

• It would be the deciding factor: 22 percent
• A big factor: 43 percent
• Some factor: 21 percent
• No factor at all: 14 percent

Taken together, 65 percent put insurance in the top two tiers. Roughly one respondent in five said coverage alone would make or break the decision.

A useful comparison: FDA approval

We asked the same question about FDA approval, and the pattern was strikingly similar. For 19 percent, approval would decide the matter, and for 40 percent it was big, together 59 percent. It mattered somewhat to 27 percent and, just as with insurance, not at all to 14 percent.

So both coverage and approval weigh heavily. But when respondents were forced to rank what mattered most in choosing a provider, the two separated sharply. With two picks allowed, 85 percent of respondents chose coverage. FDA approval made it for 27 percent, a little above fast results at 24 percent. Being close to home came second overall at 43 percent.

Our reading: people want both a legitimate treatment and one they can afford, but when they have to trade, affordability wins.

What the numbers mean in practice

A separate question put the tradeoff directly. Asked whether they would choose a covered treatment with more hoops or pay themselves for a simpler process, 51 percent took the hoops. Nearly a quarter would pay, and just over a quarter were unsure.

And the payer mix behind those answers is broad. Our respondents reported commercial plans most often, 39 percent, then Medicaid at 37 percent; Medicare covered 23 percent, TRICARE 5 percent, and 9 percent had no coverage. Respondents could choose more than one.

For a treatment that involves repeated sessions, it makes sense that coverage looms this large. A single appointment might be affordable out of pocket. A series of them, for most households, is not.

What this looks like from St. Charles

St. Charles County has a wide range of households: longtime residents on Medicare, families on employer plans, working adults on MO HealthNet, and military families on TRICARE. The survey was regional, not a count of this county, but its message applies across all of them: coverage is usually the first question, not the last.

If you live here and are wondering whether a newer treatment is within reach, three facts matter:

• Esketamine is the approved option. Marketed as Spravato, it carries FDA approval for depression that has resisted treatment, and only certified clinics may administer it, with supervision. Because it is approved, many plans will consider covering it, usually with a prior authorization.
• Other ketamine options are often self-pay. Infused IV ketamine is off-label for depression, and ketamine mailed home by online services gets less supervision. Both are commonly paid out of pocket.
• Location affects cost too. Certified sites may be in the county or across the Missouri River. Frequent early sessions, each with a required ride home, add real costs in time and travel.

If insurance is your deciding factor

You are in the roughly one in five who said so. Here is how to find out where you stand:

• Call your insurer with three questions: whether esketamine is covered, whether prior authorization applies, and which benefit, medical or pharmacy, handles it.
• Ask which certified sites near St. Charles are in network.
• If you have MO HealthNet, call the managed care plan listed on your card, since each plan has its own process.
• Begin writing down your antidepressant history today, since most approvals hinge on it. Brain Recovery Centers explains how esketamine costs and coverage decisions work for readers mapping the covered route.

If insurance is a big factor, but not everything

You have a bit more flexibility. Get the covered route moving first, then weigh it against other options with your doctor. Most people would start with that doctor regardless, as 56 percent of respondents told us.

If insurance does not matter to you

You are in the 14 percent. Even so, ask what any self-pay option actually is, whether it is FDA-approved for your condition, and how you will be monitored.

A word to the people who said "some"

The 21 percent in the middle, who said coverage would matter somewhat, often get overlooked. They may be willing to pay for part of their care, or to accept a higher copay for a closer site. If that is you, it is worth pricing both routes before deciding, because covered care can come in cheaper than feared and self-pay dearer than advertised.

The bottom line

For the large majority of people we surveyed, coverage is not a detail to sort out after deciding on treatment. It is part of the decision itself. That is not a failure of motivation. It is a realistic response to what ongoing care costs.

Nothing here is medical or financial advice; it is survey research. Whether any treatment is appropriate for you is for a clinician to decide.

If you are in St. Charles, or anywhere, and having thoughts of ending your life, cost should never be the reason you stay silent. A call or text to 988 costs nothing, and the Suicide and Crisis Lifeline behind it is open all day and all night, in every season.

Methodology

St. Charles readers can check the source. Survey 395586438 ran with Pollfish panelists and wrapped up on June 23, 2026, holding 443 completes from people 18 to 64 in Minnesota, Missouri, Ohio, Kansas, Illinois, Oklahoma, Wisconsin, Nebraska, Indiana and Iowa. Shares are rounded, and multi-select items exceed 100 in total. The figures are validated. The publisher paid for the survey at its own request.