We expected the answer to be employer insurance. It usually is, in the mental picture most people carry of who seeks out newer depression treatments: someone with a steady job, a decent plan, and a doctor who has time to talk. The data said something more complicated.

We asked the 443 adults in our summer poll, spread over ten Midwest states, how they are covered, and commercial insurance, the kind most people get through work or buy themselves, did come out on top, at 39 percent. Medicaid came in at 37 percent. Two points separate them, a gap small enough that the order matters far less than the size of both groups. The headline is that they are nearly tied, and that almost nobody plans as if they are.

These are final numbers; Pollfish has finished validating its panel.

The full picture of coverage

People could select more than one type of coverage, since some carry two. Here is how the answers fell:

  • Employer or individually bought plans: 39 percent
  • Medicaid (state programs): 37 percent
  • Medicare, including Advantage plans: 23 percent
  • No insurance: 9 percent
  • TRICARE: 5 percent
  • Preferred not to say: 2 percent

Because the question allowed multiple answers, the list sums past 100. What it shows is breadth. Public programs, Medicaid and Medicare, account for a very large share of the people in this sample. Roughly one in eleven had no coverage at all. And a small but meaningful group relies on TRICARE, the military health program.

Why this matters more than it seems

Coverage type would be a trivia question if people did not care about coverage. They care enormously. Forced to pick a pair of provider priorities, 85 percent of our respondents included insurance, far ahead of anything else, and 65 percent said the question of trying ketamine or esketamine would turn mostly or wholly on coverage.

Combine those findings and a practical consequence emerges. If a clinic or a health system prepares for the commercial-insurance patient and treats Medicaid as a later add-on, it is, by this sample, sidelining a group nearly as large as the one it planned for. More than a third of the people who might walk in could find the door closed.

What we think explains it

We did not ask respondents why they have the coverage they have, so we can only offer context, not findings. A few things are reasonable to say.

Medicaid covers a large number of working-age adults in many states, including several in our survey region that expanded eligibility over the past decade. Our sample was limited to adults aged 18 to 64, which leaves out most people on Medicare by age and may raise the relative share of Medicaid. And the Pollfish consumer panel reaches people through mobile apps, which captures a broad swath of the public rather than people already inside a specialty clinic.

None of that makes the result less real. It simply describes the kind of population these figures come from: ordinary adults across the Midwest, not a screened patient list.

What it means if you have Medicaid

If you are one of the many people covered by Medicaid, the first takeaway is that you are nearly as common here as anyone with a work plan, not the exception. Newer depression treatments are not only for people with employer plans.

Spravato is esketamine in spray form, FDA-approved for adults still depressed after other treatment, with each dose watched at a certified clinic. For Medicaid readers, Brain Recovery Centers offers a primer on esketamine costs and how coverage generally works. Whether a given Medicaid plan covers it, and under what conditions, varies by state and by plan. Most states deliver Medicaid through managed care organizations, and the one you belong to is usually printed on your card. A practical starting script:

  • "Is esketamine covered for treatment-resistant depression under my plan?"
  • "What does prior authorization require?"
  • "Which certified sites near me are in network?"
  • "Is non-emergency transportation to appointments a covered benefit?"

The transportation question matters because after every esketamine dose you stay a couple of hours or more and then need someone else to drive.

One more practical note. If you are not sure whether your plan is Medicaid managed care, Medicare Advantage, or something else, that is common, and it is fine to ask the member services line exactly that. Knowing the category tells you which rules apply before you ask about any specific treatment.

What it means if you have commercial insurance

You are in the largest group, but only by two points, and it varies more from plan to plan than people assume. Employer plans can route mental health through a separate company, list the medication under a different benefit than the visit, or set their own authorization rules. Ask specifically, and do not assume a good plan means an easy yes.

What it means if you have no coverage

Nine percent of respondents said they are uninsured. If that describes you, it is worth checking whether you qualify for Medicaid in your state, since eligibility rules have changed in many places. It is also worth asking your doctor about lower-cost care options generally, and asking any treatment site for written self-pay pricing.

The part coverage does not decide

Insurance may open the door, but people told us clearly who they want to walk them through it. For 74 percent, a doctor's recommendation would be enough to try it; an ad would move 2 percent. Whatever your coverage, the most important step is the same: bring the question to a clinician you trust, and tell them coverage matters.

Read this as market research. It gives no medical advice. Esketamine's approval is for a single condition, it is wrong for some patients, and results differ from person to person; your clinician weighs whether it fits.

Whatever card is in your wallet, a suicidal crisis needs a human voice now. Text or call 988. Help from the Suicide and Crisis Lifeline costs nothing, and no one there asks about insurance.

Methodology

Our data: a Pollfish consumer-panel study, number 395586438, open through June 23, 2026 (n=443 completes); everyone counted was 18 to 64 and lived in Oklahoma, Missouri, Illinois, Kansas, Iowa, Minnesota, Ohio, Nebraska, Wisconsin and Indiana. Coverage answers overlap, since people could name several. The figures are final and cover the whole sample. Our publisher sponsored the study at its own cost.