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 condition
- Doesn’t have a designated treatment
- Isn’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.