Updated 03/21/24Wondering if insurance covers couples therapy or marriage counseling? Whether or not your insurance company covers marriage counseling depends on your individual health plan and what type of coverage you have. While some federal laws, like the Affordable Care Act (ACA), and the Mental Health Parity and Addiction Equity Act (MHPAEA) all do require insurers to offerinsurance coverage for online therapy and mental health conditions, 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 part of an actual mental health treatment or diagnosis? The answer there is most often, no.In the instance of your health insurance plan not covering your counseling service, there are other more accessible and affordable options suchonline marriage counseling.Marriage Counseling OnlineStrengthen your marriage with the help of an experienced, licensed marriage counselor, from home and at your convenience.Start here
Updated 03/21/24
Wondering if insurance covers couples therapy or marriage counseling? Whether or not your insurance company covers marriage counseling depends on your individual health plan and what type of coverage you have. While some federal laws, like the Affordable Care Act (ACA), and the Mental Health Parity and Addiction Equity Act (MHPAEA) all do require insurers to offerinsurance coverage for online therapy and mental health conditions, 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 part of an actual mental health treatment or diagnosis? The answer there is most often, no.
In the instance of your health insurance plan not covering your counseling service, there are other more accessible and affordable options suchonline marriage counseling.
Marriage Counseling OnlineStrengthen your marriage with the help of an experienced, licensed marriage counselor, from home and at your convenience.Start here
Marriage Counseling OnlineStrengthen your marriage with the help of an experienced, licensed marriage counselor, from home and at your convenience.
Marriage Counseling Online
Strengthen your marriage with the help of an experienced, licensed marriage counselor, from home and at your convenience.
Start here
How Therapy Purpose Affects Insurance CoverageBecause insurance equity laws don’t normally extend to covermarriage counseling costs, what type of coverage you can expect often depends largely on why you’re going to therapy. Typically, insurance plans cover therapy sessions that are “medically necessary,” usually requiring an individual diagnosis of a mental health condition. It’s important to note that even if such a diagnosis exists and affects the relationship, coverage often extends only to individual therapy for the diagnosed partner, not to joint counseling sessions.This distinction means that while the presence of a mental health diagnosis may open the door to some form of therapy coverage, it usually does not include couples counseling unless the sessions can be justified as part of the individual’s treatment for the diagnosed condition. Understanding this nuance is vital for effectively navigating your insurance coverage possibilities.
How Therapy Purpose Affects Insurance Coverage
Because insurance equity laws don’t normally extend to covermarriage counseling costs, what type of coverage you can expect often depends largely on why you’re going to therapy. Typically, insurance plans cover therapy sessions that are “medically necessary,” usually requiring an individual diagnosis of a mental health condition. It’s important to note that even if such a diagnosis exists and affects the relationship, coverage often extends only to individual therapy for the diagnosed partner, not to joint counseling sessions.
This distinction means that while the presence of a mental health diagnosis may open the door to some form of therapy coverage, it usually does not include couples counseling unless the sessions can be justified as part of the individual’s treatment for the diagnosed condition. Understanding this nuance is vital for effectively navigating your insurance coverage possibilities.
WhenIs Marriage Therapy Covered?
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 gray area, depending on why you’re seeking help. In general, most commonrelationship problemswouldn’t be covered under the ACA.
However, if the treatment plan for your therapy includes help for someone who has a mental health condition like the ones listed above, an insurance company might cover the sessions.
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 and behavioral 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 insurance company directly and ask: does insurance cover marital counseling?
COBRA
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.
Medicare
Be sure to ask your therapist ifMedicarewill cover the cost of your marriage counseling.
How To Know if Your Insurance Covers Marriage Counseling
Determining whether your insurance policy covers marriage counseling involves a few steps, given the nuanced nature of health insurance benefits. Here’s how to start:
How To Get Insurance To Pay for Marriage CounselingGetting 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 benefits cover 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 mental health 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.
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:
What If You Don’t Have InsuranceCoverage?
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 family therapy for your marriage. Local programs and nonprofits are good places to start. You can also:
Start Affordable Marriage Counseling With Talkspace
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 withovercoming grief, financial issues, infertility, or anything else in your marriage, getting the right therapy is key. It might even be able to help yousave your relationship. Knowingwhat 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.
Sources
Our goal at Talkspace is to provide the most up-to-date, valuable, and objective information on mental health-related topics in order to help readers make informed decisions.
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