Is Marriage Counseling Covered by Insurance?
Key takeaways:
Most health insurance providers don’t provide coverage for marriage or couples counseling.
If a physician diagnoses you or your partner with a mental health condition, they may prescribe therapy as part of the treatment plan. Your insurance may cover your therapy sessions if they are used to treat a medical condition.
If you don’t meet the requirements for your insurance to cover marriage counseling, you may seek other affordable options.
If you and your spouse are having marital problems, seeking help is a good start to solving them. More than 75% of clients say therapy improved their relationships.
Your next concern may be, “Does insurance cover couples therapy?” The answer depends on your provider and the reason for counseling.
Below, we explain how much marriage counseling costs and whether insurance pays for your sessions. We'll also explore other options if you don’t have coverage and can’t afford therapy.
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What is marriage counseling?
Marriage counseling helps you and your partner deal with relationship issues. Through short-term psychotherapy, you can address recurring problems and uncover causes of conflict. Discussing issues such as infidelity, finances, and mental health strengthens your relationship.
It doesn’t take years in therapy for marriage counseling to work. On average, couples attend 12 sessions with a counselor. About 2 in 3 couples finish therapy within 20 sessions. Nearly 88% end counseling within 50 sessions. Both couples therapy and family therapy typically take less time than average individual treatment.
Does insurance cover marriage counseling?
Your health insurance probably won’t cover marriage counseling. Most standard plans don’t recognize relationship problems as medical issues. But most insurance plans typically cover individual therapy for mental health issues.
Let’s say a physician diagnoses you or your partner with a mental illness, such as depression or anxiety. Your insurance may cover sessions that include both parties in the treatment plan.
How can I find out if my insurance covers couples counseling?
The first step in determining whether your insurance covers marriage therapy is to review your contract. It’s up to you to know what’s covered and not covered in your health plan. Your insurance contract should explain criteria such as:
Covered services
Approved providers
Reimbursement stipulations
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Know this information before calling your provider, so you can narrow down questions and focus on missing details.
You also need to know the difference between procedural codes and diagnostic codes. A procedural code represents the services provided in a session. A diagnostic code reflects the reason for treatment.
For example: Your insurance may cover family therapy or group psychotherapy (procedural code). But it may not cover marital conflict as the reason for treatment (diagnostic code).
Asking the representative specific questions about your coverage helps create realistic financial expectations. Find out which procedural and diagnostic codes your insurance accepts for billing. If you already know the codes your therapist plans to use, ask whether insurance covers them. With these answers, there shouldn’t be any surprise bills.
How much is marriage counseling with insurance?
Your copay should be equal to or less than the copay for most medical and surgical services covered in your plan.
For example: Let’s say you have couples therapy insurance with a mental health diagnosis. The federal parity law passed in 2008 requires insurance providers to treat mental health like physical health.
The parity law applies to:
Employer-sponsored health coverage
Health insurance exchanges created under the Affordable Care Act (ACA)
Most Medicaid programs
You only pay one copay because treatment is technically for one person. The therapist would commit fraud if they charged two copays for two people attending a session. There’s also only one deductible for mental health and physical health services, thanks to the parity law.
The law also keeps insurance providers from capping the number of therapy sessions allowed per year. But your plan could require an evaluation after a certain number of appointments to determine whether ongoing treatment is medically necessary.
How does a therapist bill a couple?
Therapy sessions can range from $65 to $250 per hour. Payment is typically due after each appointment. If a couple attended 12 hour-long sessions, and each appointment cost $100, they would pay $1,200 total for the therapy.
Below are some factors that influence how much a therapist may charge for marriage counseling:
Educational background and degrees
Number of years in the field
Type of experience
Specialization
Reputation
Another factor that affects the price of couples therapy is location. Counselors in large cities charge more than therapists in small towns because of the cost of living. Also, the number of sessions you purchase may lower the cost. Many therapists offer a bundle of sessions at a reduced rate.
If you have marriage counseling insurance, you must meet your deductible before your copay kicks in. Your therapist bills your provider for each session using psychotherapy Current Procedural Terminology (CPT) codes.
If your insurance accepts relationship problems as a covered reason for couples therapy, it may use a diagnostic code like Z63.0. Otherwise, your therapist must submit the diagnostic code associated with the mental health condition they’re treating.
You pay the total bill for each session if your insurance doesn't cover couples therapy.
Does your reasoning for seeking marriage counseling impact if your insurance will cover your therapy?
When you seek marriage counseling for a mental health condition, your insurance will likely cover therapy. Once you and your partner accept this diagnosis, the provider classifies counseling as a mental health service.
Examples of mental health conditions include:
If you’re going to couples therapy for reasons other than mental health, your insurance probably won’t cover counseling. In this situation, there’s no medical health diagnosis to attach to your claim.
Examples of other reasons to seek therapy that insurance may not cover include:
Infidelity
Lack of intimacy
Poor communication
Parental differences
Division of labor
Finances
You have an alternative option if insurance won’t pay for marriage counseling without a mental health diagnosis. See if you can access an Employee Assistance Program (EAP) through your employer. These programs provide free, short-term counseling for both personal and work-related problems.
Does Obamacare cover marriage counseling?
Affordable Care Act (ACA) insurance doesn’t cover most therapy sessions for relationship problems. The reason is there’s no medical illness involved. But the ACA may cover couples for sessions that require therapy as part of a mental health treatment plan.
Does Medicare offer coverage for marriage therapy?
Medicare Part B covers family counseling as long as the primary goal is to provide mental health treatment. You and your partner can seek therapy from these types of health professionals:
Clinical psychologists
Clinical social workers
Clinical nurse specialists
Psychiatrists or other doctors
Physician assistants
Medicare doesn’t recognize marriage and family therapists (MFTs) as covered providers. If you choose an MFT, you must pay out of pocket.
Does COBRA cover marriage therapy?
The Consolidated Omnibus Budget Reconciliation Act (COBRA) won’t pay for marriage therapy if it wasn’t in your employer’s plan. COBRA allows you to extend insurance coverage after you leave your job.
Ask yourself, “Did your insurance cover marriage therapy without a mental health diagnosis during employment?” If not, you likely wouldn’t have couples counseling insurance under COBRA.
How can I get insurance to cover marriage counseling?
To ensure your insurance pays for marriage counseling, learn the requirements for coverage. You can start with the following questions:
Is a mental health diagnosis necessary?
What types of health professionals can you see?
Which ones are in your network?
How many sessions does insurance cover?
What amount do you have to spend before the copay begins?
Finally, ask for the billing codes your therapist plans to use and verify your insurance accepts them.
What can we do to continue marriage counseling if we lose our health insurance because of a job change?
You may continue marriage counseling with your current therapist. But you must now foot the entire bill because insurance won’t be available anymore. If you can’t afford this expense, ask your counselor if they offer sliding-scale payment options based on income or free/reduced fee services. This way, you may continue therapy without starting over.
If you need to find cheaper couples counseling because of a lack of insurance, check out these lower-cost options:
Churches (Local pastor may provide free counseling)
Nonprofits
Support groups
Colleges/universities
Military organizations
Marriage counseling isn’t an ongoing expense like a mortgage or car payment. Once you make some progress, sessions will likely go from weekly to bi-weekly to monthly until counseling is no longer necessary.
Where do I start my search for a therapist?
If your insurance covers couples therapy, narrow prospects based on coverage and read their reviews. If insurance isn’t a factor, ask your doctor, friends, and family for recommendations.
You may also use search engines to find therapists near you. Check out locators like the following:
Some therapists may offer a free consultation to help you determine if they’re the best fit for your needs.
Resources for individuals and couples seeking therapy
For more information on marriage counseling, take a look at these resources:
The bottom line
There are ways to get couples therapy even if your insurance doesn’t pay for your sessions. Start by defining your reason for therapy, then talk to your provider about coverage requirements. If your insurance won’t cover counseling — and you can’t afford the hourly rate — investigate lower-cost options to ensure you get the help you need.
Why trust our experts?
References
American Association for Marriage and Family Therapy. (n.d.). About marriage and family therapists.
American Association for Marriage and Family Therapy. (n.d.). American Association for Marriage and Family Therapy.
American Association for Marriage and Family Therapy. (n.d.). Need help?.
American Academy of Professional Coders. (n.d.). ICD-10-CM code for problems in relationship with spouse or partners Z63.0.
American Psychiatric Association. (n.d.). American psychiatric association.
American Psychological Association. (n.d.). American psychological association.
American Psychological Association. (2019). Does your insurance cover mental health services?.
American Psychological Association. (n.d.). Find the right psychologist for you.
American Psychological Association. (2022.). Psychotherapy codes for psychologists.
Centers for Medicare & Medicaid Services. (2021). Billing and coding: Psychiatric diagnostic evaluation and psychotherapy services.
Centers for Medicare & Medicaid Services. (n.d.). Renew your Medicaid or CHIP coverage.
GoodTherapy. (2014). How much does therapy cost?.
GoodTherapy. (2014). Does insurance cover couples therapy?.
Healthcare.gov. (n.d.). Still need health insurance?.
Healthcare.gov. (n.d.). The children’s health insurance program (CHIP).
Medicare.gov. (n.d.). Mental health care (outpatient).
National Institute of Mental Health. (n.d.). The national institute of mental health.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
