Can You Use An HSA For Marriage Counseling? Eligibility And Mental Health Options

In most cases, marriage counseling does not typically qualify as an HSA-eligible expense. However, there may be exceptions if counseling is tied to a diagnosed mental health condition and considered a medical necessity by a licensed healthcare provider. Because marriage counseling can be expensive, many couples want to know whether their health savings accounts (HSAs) can help offset the cost. Below, explore how HSA eligibility works for marriage counseling, what documentation may be required, the penalties for using funds on ineligible expenses, and affordable alternatives like online therapy.

Is marriage counseling HSA-eligible?

The short answer is that marriage counseling typically does not qualify as an HSA-eligible expense on its own. Health savings accounts are tax-advantaged accounts intended for qualified medical expenses, which the Internal Revenue Service (IRS) generally defines as costs related to the diagnosis, treatment, or prevention of a medical condition.

With many plans, individuals can only use an HSA for these specific qualified purposes. The issue of HSA eligibility can become more complicated when it comes to mental health services, which must be considered a medical necessity to qualify. In many cases, marriage counseling is not often considered a medical treatment for a qualifying medical condition. For this reason, it may not be covered by an HSA unless it can be connected to a diagnosis.

When marriage counseling may qualify for HSA coverage

There are certain situations in which marriage counseling could become an eligible expense. If the counseling addresses a diagnosed mental health condition, it may meet the IRS criteria for a qualified medical expense. A licensed healthcare provider often plays a key role in determining whether the care is a medical necessity.

Below are a few scenarios in which marriage counseling could potentially qualify:

• Counseling is provided as part of treatment for a diagnosed condition, such as depression or anxiety, that affects the relationship.
• A therapist provides documentation showing that the counseling addresses a diagnosed mental health condition.
• A provider issues a letter of medical necessity explaining why the counseling is part of a broader treatment plan.

Even in these situations, it can be important to verify eligibility with your HSA administrator before assuming the expense qualifies.

Getting a letter of medical necessity

A letter of medical necessity is a document from a licensed healthcare provider that explains why a particular service is needed to treat or manage a diagnosed condition. It may include the diagnosis, the recommended treatment, and how the counseling connects to that condition. Providers such as a physician, psychiatric provider, or licensed therapist can typically write one, and keeping a copy on file may help support your claim if questions arise later.

What is a health savings account?

When you have a high-deductible health insurance plan, you may pay lower monthly premiums but have a higher deductible for services. In the United States, those with high-deductible health plans (HDHPs) may have the option of opening a health savings account, which can help them manage their healthcare costs.

If you qualify, you can contribute to an HSA much like a savings account, with the money earmarked for eligible medical expenses. For some, an advantage of an HSA is that contributions are made using pre-tax funds. Any money you put into an HSA is tax-deductible, you don't have to pay taxes on the interest your contributions earn, and withdrawals for qualified expenses are also tax-free.

Penalties for using HSA funds on ineligible expenses

Using HSA funds for a non-qualified expense, such as marriage counseling that does not meet the eligibility criteria, can carry financial consequences. When you withdraw money for an ineligible expense, that amount is typically added to your taxable income for the year. If you are under age 65, you may also be subject to a 20% penalty on the withdrawal.

For those who are 65 or older or who have a qualifying disability, the additional penalty may be waived, though the withdrawal may still be taxed as income. Because of these potential costs, it can be important to confirm whether an expense qualifies before using your funds.

How to use your HSA for eligible therapy expenses

If your therapy qualifies as an eligible medical expense, using your HSA can be a relatively straightforward process. Individual therapy for diagnosed conditions typically qualifies, and following a few steps may help keep things organized:

1. Confirm eligibility with your HSA administrator before paying for services.
2. Obtain documentation from your provider, such as a letter of medical necessity, if needed.
3. Pay using your HSA debit card, or pay out of pocket and submit for reimbursement.
4. Keep receipts and provider documentation for your tax records.

Taking these steps to verify eligibility can help you avoid unexpected penalties and make the most of your account.

Can you use an HSA for your spouse's therapy?

An HSA is tied to an individual, even if that individual is married, but it can typically still be used to pay for a spouse's qualified medical expenses. If both partners have a high-deductible health plan, each can open a separate HSA. In that case, contribution limits may apply to the family collectively, so it can help to review those limits when planning your contributions.

Exploring online therapy as an alternative

Because HSA limitations can make marriage counseling feel less accessible, some couples look for more affordable options. In-person counseling can cost from $100 to $250+ per session on average for couples, which may make therapy less accessible for some.

Even without an HSA, therapy through an online platform may provide an effective and more affordable alternative for couples of all ages and in all stages of their relationships.

When using insurance, certain BetterHelp features may be limited or unavailable, including chat-based sessions, groups/classes, and select self-help tools.

Benefits of online therapy for couples

Couples who are concerned about the cost of therapy may find that online platforms can be more accessible. Online therapy may offer flexible pricing, often around $70-100 per week compared to traditional in-person sessions that can cost $100-250+ per session, and it can provide the flexibility to attend from home, which may make it easier for both partners to take part.

Some studies suggest that connecting with a therapist online may be just as helpful as meeting in person. For instance, a recent study found that online couples therapy demonstrated comparable outcomes to in-person couples therapy. Findings like these suggest that couples can feel supported through virtual care. If this feels like the right next step, you can get started at your own pace.