Our relationships are central to our health. When there's a strain between partners, it's normal to feel like you need help. Couples therapy can provide support for you and your partner in hard times as you work through issues.
Couples therapy can be costly. If your therapy is covered by insurance it can be a big relief. This is even more true if some of your conflicts are related to money. Here’s how to know when or if couples therapy is covered by your insurance.
How Often Is Couples Therapy Covered?
Couples therapy is not covered under most standard health insurance plans. Here’s a quick guide to different types of insurance. Find out what you should expect under these policies.
ACA Health Insurance
Mental health services coverage is included in Affordable Care Act (ACA) insurance. It is listed as an “essential benefit.” But, couples therapy for normal relationship issues is not offered in ACA policies.
Why isn't couples therapy covered by most ACA health plans? Because it is not:
- A treatment for an illness or mental health issue. Instead, it is a treatment used to help two people improve their relationship.
- Categorized as a mental health service. Those services involve diagnosing and treating people with mental disorders, or diseases. Relationship problems aren’t classified as such.
- Usually considered “medically necessary.” This is 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. These problems may include adult schizophrenia, affective (mood) disorders, alcoholism, and drug abuse. In these cases, an insurer may cover treatment, as long as the proper medical billing codes apply.
Due to the complicated nature of treatment definitions, it is best to speak to your insurer to ask if there is any coverage in your plan. Most of the time, it will not be covered.
Employer-Sponsored Group Insurance
Most often, couples therapy is not covered by standard health insurance. But, it may be covered under your employer’s Employee Assistance Program (EAP). Many employers offer an EAP because improving the well-being of their workers can boost productivity and reduce absenteeism.
Contact your benefits manager and ask what coverage is available for couples therapy. Find out 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,” know that couples therapy may not fall under this definition. Also, most short-term health insurance policies have exclusions. Many will not cover mental health services. You will have to contact the insurer to find out.
COBRA plans may cover couples counseling if your employer group insurance or EAP had that coverage. This is because COBRA is based on giving you the same health insurance you had when you were employed.
Medicare Part B covers family counseling if the main purpose is to help with your treatment. The counseling must also be given by a behavioral health care provider such as a psychiatrist, physician, clinical psychologist, or clinical social worker.
Medicare usually does not provide coverage for family or couple counseling if it is with a licensed MFT. The exception is if the MFT is an employee of a clinical facility or a staff member at an office of a Medicare-eligible practitioner.
How to Get Your Insurance to Pay for Couples Therapy
If your insurer does not cover 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 if your insurer 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. For instance, your insurer may say that you can (or cannot) get therapy from certain types of professionals. Or, your insurance may limit you to professionals who are “in-network.”
Each insurer will have its own 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 addressing is covered. Ask your therapist for the billing code they will use. Then, call your insurer to ask if they cover that code. If it is couples counseling, the therapist will not use the same code as for individual therapy.
Protect yourself from surprise bills. Be sure that you know what you will be getting treatment for.
Can You Use an HSA or FSA to Help Pay?
Couples therapy is not an “eligible expense” under your health savings account (HSA) or flexible spending account (FSA). 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 account when making a budget. If you get a "free trial," find out what the cost will be after your lower rate is over.
Where to Get Couples Therapy if You Can’t Afford It
Any counseling 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 programs or nonprofit orgs. Here are some tips:
- Speak to your doctor and ask if they can point you in the direction of some couples therapy services.
- Contact your local college or mental health center. Discounted rates or programs may be available to you.
- If you are a member of a church, contact them to see if they offer couples therapy. You may be able to get some help for free.
- Even if your insurance does not cover couples counseling, be sure to inform yourself about what mental health coverages they do provide. You may be able to get individual counseling. This could help you in other ways.
- Don’t forget to check your partner’s health insurance for coverage, too.
- There are services that offer online counseling for reasonable fees. Studies have shown good success rates. You can also do a search for “free couples therapy” online for some ideas in your metro area. Keep in mind that online services usually come with a fee. This is true even if they have a free trial. It may be cheaper than face-to-face counseling, but there are costs for any form of counseling.
- When looking into counseling, ask about discounts if you buy more than one session. Many therapists will work with you to come up with a payment plan.
Know Before You Go
Our life at home affects our well-being. Couples therapy can be a good option for helping get things back on track. Because most health insurance won’t cover couples therapy, learn about payment options. Find out what your policy will pay for before starting a course of treatment.