Is Couples Therapy Covered by Health Insurance?

When Counseling Is Covered Plus Tips to Save Money on Costs

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Our relationships form a central part of our well-being; when there’s a strain in your relationship, it is only natural to feel like you need help. Couples therapy is one option that can provide support for you and your partner in difficult times as you work through issues. 

Couples therapy can be expensive. If your therapy is covered by insurance it can be a big relief, especially if some of your disagreements are money-related. But that’s fairly rare. Here’s how to know when or if couples therapy is covered by your insurance.

How Often Is Couples Therapy Covered?

Depending on the kind of insurance you have, you may or may not have coverage. In general, couples therapy is not covered under most standard health insurance plans.

Here’s a quick reference guide to different types of insurance and whether you should expect to have coverage under these policies for couples therapy or counseling.

ACA Health Insurance 

Mental and behavioral health services coverage is included in Affordable Care Act (ACA)-compliant insurance as an “essential benefit” for individuals. Unfortunately, although having a harmonious relationship at home is good for overall mental health, couples therapy for normal relationship issues is not one of the coverages offered in ACA health insurance policies. 

In order to understand why couples therapy is not normally covered by ACA health plans, we have to understand certain definitions.

Couples therapy is not:

  • Considered part of the essential benefits because by definition, marriage or couples therapy is not a treatment for an illness or mental health issue. Instead, couples therapy is a treatment used to help two individuals improve their communication or relationship. 
  • Categorized as a mental health service because those involve diagnosing and treating people with mental disorders, or diseases; relationship problems aren’t classified as such.
  • Usually considered “medically necessary” because medical necessity requires that health services treat a disease, injury, condition, or illness. 

Sometimes, marriage and family therapy (MFT), which can include couples therapy, may be part of the treatment plan when an individual suffers from mental health problems such as adult schizophrenia, affective (mood) disorders, alcoholism, and drug abuse. In these cases,an insurance company may consider coverage, provided the proper procedure or medical billing codes apply.

Due to the complicated nature of treatment definitions it is best to speak to your insurance provider to ask if there is any applicable coverage in your plan; normally, it will not be covered.

Employer-Sponsored Group Insurance

Couples therapy typically is not covered by standard health insurance but may be covered through an employee benefits plan under your employer’s Employee Assistance Program (EAP). Having a wellness program or EAP is considered beneficial for many employers because they feel that focusing on the well-being of their employees, including their mental health, can contribute to improved performance and reduce absenteeism. Contact your benefits manager and ask what coverage is available for couples therapy and how the coverage is defined in the policy.

Short-Term Health Insurance 

Although your short-term health insurance policy may have coverage for “mental health,” it is important to remember that couples therapy may not fall under this definition. In addition, most short-term health insurance policies have exclusions and many will not cover mental health services. You will have to contact the insurance company to find out.

COBRA

COBRA plans may include some coverage for couples counseling if your employer group insurance or EAP included the coverage because COBRA is based on providing the same health insurance you had when you were employed.

Medicare

Medicare Part B covers family counseling, if the main purpose is to help with your treatment and it is provided by a behavioral health care provider such as a psychiatrist, physician, clinical psychologist, clinical social worker, or a nurse specialist. Medicare does not provide coverage for family or couple counseling if it is with a licensed MFT unless they are employees of clinical facilities or are staff members at clinical offices of Medicare eligible practitioners. 

How to Get Your Insurance to Pay for Couples Therapy

If your insurance company does not provide benefits for couples therapy, do not expect to be able to claim your expenses. 

It is common practice for a therapist to require you to sign an agreement stating that even if your insurance company does not pay for coverage, you will be responsible. 

If your insurance covers couples counseling, you may still need to meet certain requirements before your expenses are paid.

To get your insurance benefits to pay for couples therapy, you may need to meet certain requirements like:

  • Your insurance may define you can (or can not) obtain the therapy from, for example professionals like a psychiatrist, physician, clinical psychologist, clinical social worker, nurse specialist or others.
  • Your insurance may limit you to professionals “in-network.”

Each insurance company will have different criteria, check this before you start booking appointments to avoid out-of-pocket costs.

Medical billing codes are very specific to what kind of counseling you get; be sure that the issue you are getting counseling for is covered. Ask your therapist for the billing code they will use and specifically ask your insurance company if they cover that code. If it is couples counseling, the therapist will not use the same code as for individual therapy.

Asking for the medical billing code and checking with your insurance before using a therapist is important in order to protect yourself from surprise bills and to ensure that you understand what you will be receiving treatment for.

Can You Use an HSA or FSA to Help Pay? 

Couples therapy is not an “eligible expense” under your health savings account (HSAs) or flexible spending account (FSAs), if you have one, so if you did use money from your HSA or FSA to pay for sessions, there’s a good chance you would be paying taxes on any funds you use. Ask your HSA or FSA administrator what your options are.

Most counseling is part of a process that takes time.Take this into consideration when making a budget for counseling, or if you try a “free trial” with any provider. Find out what the cost will be after your discounted rate or trial is over.

Where to Get Couples Therapy If You Can’t Afford It

Any counseling usually costs money, and couples therapy will not be covered by standard health insurance in most cases. In instances where you can’t afford therapy, you may be able to get some help through local community initiatives or nonprofit organizations. Here are some tips:

  1. Speak to your doctor or a social worker and ask if they can point you in the direction of some couples therapy services.
  2. Contact your local university or mental health center. Discounted rates or programs may be available to you.
  3. If you are a member of a church or spiritual organization, contact them to see if they offer couples therapy. You may be able to get some help for free.
  4.  Even if your insurance does not cover couples counseling, be sure and inform yourself about what mental health coverages they do provide. If couples counseling is not covered, you may be able to get individual counseling, which could help you in other ways.
  5. Don’t forget to check your partner’s health insurance or employee group benefits plan for coverage. too.
  6. There are also services that offer online counseling for reasonable fees and in some cases, offer subsidized online therapy, if you can’t afford it. Although online therapy may seem like it would not be effective, certain studies have shown good success rates. One online organization offering couples therapy is Betterhelp.com, through its service called ReGain. You can also do a search for “free couples therapy” online for some location-based suggestions. Keep in mind that online services usually come with a fee, even if they have a free trial, and although the costs may be less than traditional face-to-face counseling, there are costs associated with this form of ongoing counseling.
  7. Finally, when looking into counseling, ask about discounts or special pricing if you buy multiple sessions. Many therapists will assess your situation and will work with you to come up with a feasible payment schedule or plan.

Know Before You Go

What goes on at home in our relationships can significantly affect our well-being. Couples therapy can be a good option for helping get things back on track and improving life overall. Because most health insurance policies won’t cover couples therapy, educate yourself about payment options, and whether your policy will reimburse for couples therapy expenses before committing to a course of treatment. 

Article Sources

  1. Healthcare.gov. "Mental Health & Substance Abuse Coverage." Accessed Jan 23, 2020.

  2. Mayo Clinic. "Marriage Counseling." Accessed Jan. 23, 2020.

  3. U.S. National Library of Medicine National Institutes of Health. "What Is Primary Care Mental Health? WHO and Wonca Working Party on Mental Health." Accessed Jan. 23, 2020

  4. American Association for Marriage and Family Therapy. "About Marriage and Family Therapists." Accessed Jan. 23, 2020

  5. U.S. Office of Personnel Management (OPM) "What Is an Employee Assistance Program (EAP)?" Accessed Jan. 23, 2020

  6. U.S. Department of Labor. "FAQs on COBRA Continuation Health Coverage." Page 5. Accessed Jan. 23, 2020.

  7. American Psychological Association. "10 Ways Practitioners Can Avoid Frequent Ethical Pitfalls." Accessed Jan. 23, 2020

  8. University of Chicago Human Resources "Health Care FSA." Accessed Jan. 23, 2020