Does insurance cover marriage counseling?

If you and your partner are experiencing concerns within your marriage, you may want to explore marriage counseling. Counseling can help the two of you recognize unproductive relationship behaviors and patterns and learn new ways to address conflict. Marriage counseling can make a significant difference in a relationship or marriage. One study found that over 70% of couples who completed couples therapy reported an increase in levels of relationship satisfaction. 

Marriage counseling is typically not free and can be expensive. If you have health insurance, you may be wondering if your insurance provider will cover all or some of the cost of couples therapy. In some cases, you may be able to use health insurance coverage to offset therapy costs, but in other cases, you might need to seek out other resources, such as an employee assistance program or an online therapy platform. Your insurance benefits may or may not cover mental health treatment in the form of marriage counseling.

Is a diagnosis necessary when insurance covers marriage counseling?

It is possible to use health insurance to pay for many forms of individual and couples counseling. Since the passage of two insurance equity laws, the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA), all health insurance providers are required to cover care for mental health conditions in the same way they cover care for physical health conditions. The Affordable Care Act and the Mental Health Parity and Addiction Equity Act apply to all health insurance plans offered by an employer, through the public federal health insurance marketplace, under the Children’s Health Insurance Program (CHIP), and through most forms of Medicaid. If you have healthcare insurance coverage, odds are that your insurer is complying with the ACA and MHPAEA to provide mental health parity.

Insurance for marriage counseling vs. other types of counseling

However, offering insurance coverage for mental health conditions may not necessarily mean covering all forms of therapy. Couples therapy sessions are often intended as a way of addressing specific challenges within a relationship, not as a treatment for mental health concerns. In this instance, marriage therapy would not be eligible for insurance coverage. 

If you or your partner have a diagnosis that may make your marriage counseling eligible for health insurance coverage, consider working closely with your insurance company to ensure the therapy provider you choose is within the company’s network of covered care. Most insurance companies have databases of providers that are in-network. If you are already meeting with a couples therapist that both you and your partner like and want to stay with, you may want to contact your insurance company. You can check to see if that counselor is in their coverage network and what your options may be if they are out of network. 

Medicare insurance coverage for marriage counseling

Medicare is the health insurance program operated by the United States government to provide mental and physical health care coverage to people who are age 65 or older. Medicare Part B is the component of the program that marriage counseling costs would likely fall under since it provides coverage for “medically necessary” conditions, including mental health care.

Medicare insurance coverage: Things to know

If you are 65 or older and eligible for Medicare, you may be able to use Medicare insurance to cover the cost of your marriage counseling. However, keep in mind that Medicare has more specific limits on what kinds of providers are covered under the program. Thus, you may have a smaller pool of counselors and therapists to choose from. The following types of providers are covered under the Medicare program:

• Licensed clinical social workers (LCSWs)
• Clinical nurse specialists
• Clinical psychologists
• Nurse practitioners
• Physician assistants (PAs)
• Psychiatrists, doctors, physicians, and anyone with a legitimate medical degree

Even if you find a provider that you and your spouse want to work with who has a licensed clinical social worker designation or falls into one of the other categories on the list, you may still want to double-check with a Medicare representative to ensure that your care will be covered by the program. 

You may notice one type of provider missing from the list above: a marriage and family therapist. Marriage and family therapists are typically not covered by the Medicare program unless they also hold certifications and licensures that include them in one of the eligible categories, or, in rare cases, when they work for a provider that is eligible for Medicare coverage (e.g., if they are part of a larger hospital system). Therefore, counseling covered by insurance through Medicare likely wouldn’t include sessions guided by a licensed marriage counselor.

When insurance coverage doesn’t apply

If you can’t work out a situation with your insurer where they are willing to provide coverage for marriage counseling, don’t despair. There are other options available to get free or lower-cost couples counseling services. These may include:

Employee assistance programs (EAPs)

Employee assistance programs are pay benefits some employers offer to allow their employees connection to free or lower-cost mental health care. Typically, with an employee assistance program, an employer will contract with an external mental health services provider, which will then provide employees with mental health care. This care typically includes individual therapy, family therapy, couples therapy, and connection to some types of behavioral health services such as addiction treatment. Unlike an employer-sponsored health insurance plan, an EAP does not require a diagnosed mental health condition, and since the employer is subsidizing the cost, you likely won’t have to pay out of pocket for therapy. If you do, it will usually be a smaller amount.

Consider checking with your employer and your spouse’s employer to see if either of you may have an extension to marriage counseling through an EAP. Some EAPs have limits on the number of sessions you can attend or the types of therapeutic techniques provided, so it could be worthwhile to determine if EAP care is the right option for you and your partner.

Local mental health services

Many cities and communities connect citizens to local mental health resources that could offer free or low-cost marriage counseling themselves or connect you to a provider who does. These services may include:

• A local college or university mental health center may be eligible for grants from the federal government to provide free or low-cost mental health care services.
• Local nonprofits
• Churches may offer free couples therapy, even if you are not a member or you do not regularly attend church services. However, it may be important to note that this form of therapy may be provided by a pastor or priest who might not be a licensed mental health professional or marriage counselor.
• City, county, or state mental health service offices
• You may also want to seek out professionals who offer sliding scale fees for their clients. This generally means that you may pay a lower amount for your sessions according to your income.

Online therapy providers that don’t require insurance coverage

If you have exhausted your insurance and therapist cost adjustment options, do not have a connection to an EAP, are not satisfied with the care you are receiving through your EAP, or can’t find a supportive alternative through local or community resources, there are still other options to get couples therapy covered or to seek help in another way. For instance, you may want to consider an online therapy provider to get the help you need. 

While online marriage counseling is not free, it is often cheaper than traditional in-person therapy, particularly if your insurance plan does not cover the mental health services you need. With online therapy, you can match with a licensed therapist according to your preferences and needs and meet with them from the comfort of your home. The ease and convenience of online therapy can make it a much more available form of care for couples with separate work schedules.

Efficacy of online therapy

Online therapy may be just as effective as traditional therapy options when it comes to marriage counseling. One study showed that couples who participated in an online couples counseling program believed it brought them closer together than in-person therapy did, and they also appreciated the flexibility and convenience online therapy provided. Online therapy can be a more financially sustainable form of couples counseling, and it may also be less stressful to attend than in-person therapy, which can involve commute times and complicated scheduling processes.