Whether or not your insurance covers marriage counseling depends on your individual plan and what type of coverage you have. While some federal laws, the Affordable Care Act (ACA), and the Mental Health Parity and Addiction Equity Act (MHPAEA) all do require insurers to offer coverage for mental health conditions, unfortunately, this typically doesn’t apply to marriage counseling.
Why? It can get a bit tricky. Even though acts and laws have been passed requiring mental health conditions to be covered just like physical health conditions, the question becomes, is your need for marital counseling an actual medical health diagnosis? The answer there is most often, no.
In the instance of your health insurance plan not covering your counseling, there are other more accessible and affordable options such online marriage counseling.
So, in what cases does insurance cover marriage counseling? Read on to find out more.
How Often Is Marriage Therapy Covered?
Because insurance equity laws don’t normally extend to cover marriage counseling costs, what type of coverage you can expect often depends largely on why you’re going to therapy. It may be covered if the decision to seek help stems from a mental health condition — think: sex addiction, schizophrenia, alcoholism, mood disorders, etc.
Because the above are categorized as mental health conditions, therapy can be considered medically necessary. There are a few other situations where you might be able to get your marital counseling covered by your insurance. We’ll cover some of the big ones here.
Affordable Care Act (ACA) insurance
The Affordable Care Act (ACA) lists mental health services as an essential benefit. That means coverage is included. However, actual couples therapy can be a grey area, depending on why you’re seeking help. In general, most common relationship difficulties wouldn’t be covered under the ACA.
Your therapy sessions likely won’t be covered by the ACA If the reason you’re going to therapy:
Isn’t an official mental health conditionDoesn’t have a designated treatmentIsn’t “medically necessary”
However, if the treatment plan for your therapy includes help for someone who has a mental health condition like the ones listed above, an insurer might cover the sessions.
The best way to know if your marriage therapy will be covered is by talking to your therapist and asking how they’ll be billing your sessions as well as contacting your insurance provider.
Employer-sponsored group insurance
Standard insurance that you get through your company generally won’t cover marriage counseling. However, it may be covered if your employer offers what’s known as the Employee Assistance Program (EAP).
EAPs have become more common with the rise in popularity of the concept of work-life balance. More employers now see the benefit of their employees being well-rounded in all aspects of their life. A more balanced lifestyle can help reduce the number of days of missed work and increase productivity, giving employers even more incentive to offer plans that emphasize mental health well-being.
Ask your company’s benefits manager what type of coverage your plans offer and if they provide access to an EAP.
Short-term health insurance
Some short-term policies do offer coverage for mental health, but marriage counseling isn’t always included in that coverage. Treatment for mental health conditions is often listed as an exclusion to many short-term plans.
You should reach out to the individual insurer directly and ask: does insurance cover marital counseling?
The Consolidated Omnibus Budget Reconciliation Act (COBRA) offers rights to workers and their families who have lost health benefits. COBRA allows people to maintain health benefits that were once provided by their employer for a limited time (even if the employee is no longer employed). Some COBRA plans might cover marital therapy, as long as your original plan had EAP coverage.
Because COBRA plans are based on the same insurance you had through your employer, you should contact your previous company’s benefits manager to explore whether or not marital counseling might be covered.
Family counseling is generally covered under Medicare Part B. For coverage to apply, the therapy needs to be directly related to treatment and conducted by a psychiatrist, clinical psychologist, physician, or clinical social worker. Most often, Medicare will not cover marital counseling from a licensed MFT. There are some exceptions to this, however. For example, sessions might be covered if the MFT is a staff member or employee of a Medicare-eligible practitioner’s office.
Be sure to ask your therapist if Medicare will cover the cost of your marriage counseling.
How To Get Insurance To Pay for Marriage Counseling
Getting insurance to pay for your marriage counseling can be a process. Understanding the steps and some additional important pieces of information can help with insurance coverage. Things to keep in mind include:
Be sure you understand whether or not your insurance covers marital counseling. If they do not, you won’t be able to claim the expenses associated with your sessions.Know what your insurance requires in order for your therapy sessions to be covered. For example, do you need to seek therapy from a specific type of professional? Are you limited to in-network providers?It’s important to fully review your insurer’s criteria regarding what services are covered and how much they’ll pay. Ask your therapist ahead of time what billing code they will use to submit their claim. You can then call your insurer and give them the code to see what will be covered. Note that couples counseling would be a different code than individual therapy ever would be.
What If You Don’t Have Insurance?
If your insurance doesn’t have marital counseling coverage, or if you don’t have insurance, all hope is not lost. There are still ways to find affordable or even free therapy for your marriage. Local programs and nonprofits are good places to start. You can also:
Ask your family doctor for a referral. Let them know therapy cost is a concern.Reach out to a mental health center in your area. Ask about discounted rates or sliding scale fees that might be available.Get in touch with your local college or university clinic and see if they offer services — many work under grants from the National Institute of Mental Health. Explore your plan’s out-of-network benefits option.Some churches offer couples therapy for free.Ask your insurance what mental health coverage they do offer. Individual therapy might be an option and can be a good place to at least start. Be sure to check both your and your partner’s coverage.Check online counseling platforms like Talkspace — many have reasonable fees, and some even offer free trials to start visiting a marriage counselor.Ask your employer if they have or would consider offering an Employee-Assistance Program (EAP).Ask your therapist if they will bill sessions under one partner’s plan, as long as one of you meets the criteria for a mental health diagnosis that qualifies for coverage. Ask your therapist if they offer multiple session discounts if you book in advance.Ask your therapist if they offer a payment plan.
Wondering if insurance covers marriage counseling is the last thing you want to worry about. It can be stressful — especially if you’re already not in a great place in your relationship. If you’re struggling with overcoming grief, financial issues, infertility, or anything else in your marriage, getting the right therapy is key. It might even be able to help you save your relationship. Knowing what to expect from marriage counseling, how to get some of your therapy paid for, and when and how insurance can kick in will all help alleviate some of that anxiety you might be feeling right now.
If you’re looking for marriage counseling near you, try Talkspace couples therapy for a convenient option.
Continuation of Health Coverage (COBRA). U.S. Department of Labor. https://www.dol.gov/general/topic/health-plans/cobra. Accessed October 2, 2021.NIMH » Home. Nimh.nih.gov. https://www.nimh.nih.gov/index.shtml. Accessed October 1, 2021.Healthcare.gov. “Mental Health & Substance Abuse Coverage.” https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/. Accessed October 2, 2021.U.S. National Library of Medicine National Institutes of Health. “What Is Primary Care Mental Health? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777553/ . Accessed October 2, 2021.The Mental Health Parity and Addiction Equity Act (MHPAEA) | CMS. Cms.gov. https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet. Accessed October 2, 2021.
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