Will Insurance Cover Couples Therapy for My Partner and Me?

Couples counseling focused on resolving basic marital problems such as lack of communication or intimacy often isn’t covered by health insurance. However, it should be covered if it is prescribed by a psychiatrist as part of a medically necessary treatment plan for a mental health disorder.

Keep reading to learn more about when marriage counseling is covered by insurance including how coverage can vary depending on the type of health plan you have.

On This Page

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  What Is Marriage Counseling?

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  When Is Marriage Counseling Covered by Insurance?

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  How Do I Know if My Insurance Covers Marriage Counseling?

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  How Much Is Marriage Counseling With Insurance?

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  How To Get Insurance To Pay for Marriage Counseling

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  FAQs

What Is Marriage Counseling?

Marriage counseling is a type of therapy aimed at resolving interpersonal issues between partners in a long-term romantic relationship. Treatment may involve a mix of one-on-one sessions and sessions where both partners are present. On average, recipients of marriage or family therapy undergo 12 sessions, with about 66% of cases being resolved in 20 sessions or less and 88% of cases being resolved in 50 sessions or less.^[1]

Examples of issues that are commonly discussed in marriage counseling include the following:^[2]

When Is Marriage Counseling Covered by Insurance?

Typically, marriage counseling is only covered by insurance in limited circumstances. See the following sections for more details about when certain types of health plans may provide coverage for marriage therapy.

Affordable Care Act (ACA)

All ACA-compliant health plans are required to cover counseling as a form of behavioral health treatment for mental health or substance use disorders.^[3] That said, insurers generally have the leeway to deny or revoke coverage for counseling if a medical professional does not determine that it is medically necessary for you.^[4]

As a result, marriage counseling you receive for any of the reasons mentioned in the above section likely would not qualify for health insurance coverage since none of them constitute medical conditions that require psychological treatment.

However, you may qualify for coverage if a psychiatrist determines that you need to undergo marriage counseling to manage or treat health problems such as these:^[1]

• Schizophrenia
• Mood disorders
• Alcoholism or drug abuse
• Anorexia
• Chronic physical illnesses

Employer-Sponsored Group Insurance

Employers that obtain group health insurance from a private insurance company must adhere to the ACA, meaning their plans will cover any type of counseling that is deemed to be medically necessary. However, large companies that directly pay for their employees’ health care rather than purchasing insurance are not required to cover essential health benefits like psychotherapy and other mental health services.^[3]

You should note that all ACA-compliant plans are required to follow the guidelines of the Mental Health Parity and Addiction Equity Act, which means they must provide similar coverage for mental health care as they do medical health care. For example, a non-self-insured employer cannot require a higher copay for psychologist visits than it does for comparable doctor visits.^[4]

Even if your job-based health plan won’t cover marital counseling in your situation, your employer may still help you take care of the costs of counseling if it offers an Employee Assistance Program (EAP). EAPs can provide a range of free services for employees including short-term counseling for personal and family issues.^[5]

COBRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a law that gives you the option to remain on your work-based health plan for up to three years after leaving your job in certain cases, allowing you to maintain the same level of coverage for marriage counseling that you had under your former employer.^[6]

In addition, if your employer offers an EAP that provides coverage for any medical services, then it may qualify as a group health insurance plan, meaning you would also be able to extend your EAP benefits through COBRA.^[7]

Short-Term Health Insurance

While it is possible for a short-term health insurance plan to provide coverage for medically necessary counseling sessions, these types of policies do not have to follow the standards set by the ACA, which means it’s also possible for a short-term health plan not to provide any sort of mental health coverage at all.^[8]

Medicare

Visits with marriage and family therapists may be covered as a type of outpatient mental health treatment under Medicare Part B, also known as Medicare medical insurance. However, Medicare will only cover these sessions if their primary purpose is to help with the treatment of a mental health condition.^[9]

How Do I Know if My Insurance Covers Marriage Counseling?

The best way to find out if your health plan covers marriage counseling is to check your insurance contract or, if the details of the policy are unclear, contact your health insurance company to confirm whether it would cover counseling sessions given your circumstances.

How Much Is Marriage Counseling With Insurance?

Insurance copays for covered marriage counseling typically range from around $30 to $50 per session, although you’ll have to cover all of the costs until you reach your deductible for the year.^[10] Meanwhile, if you’re on Medicare and have hit your Part B deductible, you will have to make a coinsurance payment equal to 20% of the Medicare-approved amount for each counseling session.^[9]

As a Medicare member, you could also face an additional copay if your counseling session occurs in a hospital outpatient department or clinic as opposed to a health care provider’s office or a community mental health center.^[9]

How Much Does Marriage Counseling Cost Without Insurance?

If you don’t have health insurance that will cover your marriage therapy, you can generally expect to pay around $75 to $250 per session.^[10] As a result, if you and your spouse go through a standard 12-session treatment plan, you could end up spending as much as $3,000 without coverage, while the same treatment may only cost around $600 out of pocket with insurance.

How To Get Insurance To Pay for Marriage Counseling

One way to make sure whether marriage counseling will be covered by your insurer is to ask your therapist what CPT and ICD-10 codes they plan to use for billing purposes and then ask your insurance carrier whether it covers those specific billing codes. CPT codes identify what services you receive, while ICD-10 codes identify the diagnosis that causes you to need those services.^[11]

Additionally, you should consider shopping around through SmartFinancial to maximize your odds of finding a plan that will cover marriage counseling and meet your other health care needs at an appropriate cost. You can click here to start comparing health insurance quotes for free.