What Does Couples Therapy Insurance Cover?

Couples counseling can benefit many couples navigating relationship challenges. Intimacy and sex, previous relationships, finances, infidelity, and trust are some topics that may be addressed with a couples therapist. Along with facilitating the discussion of these challenges, couples therapy may help relieve tension that’s affecting the mental health of the individuals in the relationship. As an impartial party, the therapist can introduce a safe space to discuss sensitive topics and offer valuable management skills to relieve stress between you and your partner. 

However, many people find that they are not covered by insurance for this purpose alone, as health insurance coverage may only pay for certain kinds of therapy. Read on to find out whether your health insurance may cover couples counseling and learn ways to get free or affordable therapy.

The ins and outs of health insurance

When billing the insurance company, therapists who take insurance usually must list a primary patient with a diagnosed mental health condition. This means one of the partners in couples therapy must be diagnosed with a mental health disorder. 

Unless their therapy is connected to a mental health condition, such as anxiety, depression, or substance use disorder, many insurance companies may not cover couples counseling. However, as many individuals' mental health conditions are affected by their relationship, a family and marriage therapist working in-network with an insurance company may bill under the mental health condition diagnosis. 

For example, if one of the partners is experiencing depression, the therapist may use the insurance code corresponding to that diagnosis. 

The Affordable Care Act

Under the Affordable Care Act, mental health services are considered an "essential benefit." Those who work for a company with more than 50 employees are usually entitled to health insurance (including mental health) that covers 60% of medical expenses. The remaining part for which the employee is responsible should be, at most, 9.5% of their family’s income.

Those who aren't eligible to receive insurance through an employer but qualify for state or federal programs such as Medicare may also receive coverage for mental health expenses with an in-network therapist. 

Short-term health insurance may also cover couples therapy in connection with a diagnosed mental health condition. However, not all marriage and family therapists operate within the same framework, so it's advisable to ask whether the therapist you are considering accepts couples therapy insurance. Health insurance coverage may also accept family therapy as a treatment option.

Since every insurance plan is different, you may need to check with your insurance company to determine the number of sessions you're entitled to and whether the therapist must be a network provider. 

Employee assistance programs

Intended to address mental health conditions that can impact job performance, some employee assistance programs (EAPs) offer a limited number of family and couples counseling to their employees as part of the benefits package. 

Those who partake in the company's EAP may be offered a free assessment, short-term counseling, and referral to an outside therapist. However, employee assistance programs differ in scope, and some may prioritize certain issues, such as substance use disorders. Depending on the company's EAP structure, some may offer in-house or external programs for family therapy. Member assistance programs like those provided by unions may also offer family counseling. 

Reach out to your benefits manager to learn more about therapy coverage

Your company's benefits manager may be able to clarify what you are entitled to for couples therapy, the number of sessions, and other applicable details. If you are planning on receiving counseling through an employee assistance program, you may inquire whether the therapist you plan to see is part of the network.

If your former employer offered an EAP but you are no longer part of the company, Continuation of Health Coverage (COBRA) plans may also offer couples counseling. 

Alternatives to insurance

These might include:

• Local colleges or mental health centers offering couples therapy
• Faith-based programs offered by a church, congregation, or other organization
• Sliding-scale payment options from therapists in an in-person practice
• Online therapy sessions with licensed therapists

Mental health conditions counseling may address

According to the American Psychological Association, couples and family psychology (CFP) is defined as a specialty in which the couple, family, and society are viewed holistically and in relation to one another. It focuses on the emotions, thoughts, and behaviors of the individuals in the relationship as a unit and in relation to their environment in "systemic relational systems." 

Some of the topics that may be addressed in couples and family psychology may include:

• Sexual, physical, or verbal abuse*
• Intimacy and trust issues 
• Dissatisfaction with the relationship
• Infidelity
• Family relationships
• Mental health conditions, such as bipolar disorder and depression
• Alcohol and drug use
• Caring for elders or a child with a chronic illness

*If you think you may be experiencing domestic violence or intimate partner violence, help is available with the National Domestic Violence Hotline. You can reach the Hotline via the website or by calling 1-800-799-SAFE (7233).

A marriage and family therapist (MFT) may diagnose and address mental health conditions concerning the family unit. Conditions commonly addressed by a marriage and family therapist may include:

• Eating disorders
• Conduct disorder 
• Sexuality and sexual or intimate wellness
• Personality disorders

Marriage and family therapists can practice in various settings, including in-person practice, inpatient facilities, community mental health centers, research centers, and employee assistance programs. 

Potential benefits of couples therapy for individuals

According to the American Association of Family and Couples Therapy, the relational approach to treating mental disorders in association with the person's relationship and family unit may, in some cases, be equally or even more effective than therapy that addresses the individual's condition alone. 

Research findings support using marriage and family therapy in addressing substance use disorders, for example. The approach has been found to help reduce family and marital conflict, improve communication, and lower the severity of underlying substance use disorders.

Online counseling may be a good fit for you and your partner

You may want to consider online therapy if you are looking for options other than insurance-covered therapy. An online couples therapist can facilitate communication between you and your partner and help you address the challenges you may be experiencing as a couple or individually, regardless of whether it's in relation to a diagnosed mental health condition. 

Many people find it helpful to discuss their feelings with a counselor, as the therapist may help mediate the discussion of sensitive topics. An online therapy platform may allow you to meet with your couples therapist via video call, phone, or online chat, which is often more convenient than in-person therapy for many people.

Research shows that online couples therapy may be as effective as in-person therapy. A large majority of therapists (74%) in one study considered online therapy useful, and an even bigger portion of couples (95 %) found it helpful in their relationships. The correlations among mental health, self-esteem, and healthy romantic relationships are also well-documented.