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.” However, couples therapy for most relationship issues is not offered under ACA policies. Why isn’t couples therapy covered by most ACA health plans?
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. It’s not 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.It is not 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, is 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 those cases, an insurer might cover treatment, if the proper medical billing codes apply. Due to the complicated nature of treatment definitions, it is best to speak to your insurer to ask whether there is any coverage in your plan. However, 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 might not fall under this definition. 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
COBRA plans may cover couples counseling if your employer group insurance or EAP had that coverage, because COBRA is based on giving you 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. The counseling must also be given by a behavioral healthcare provider such as a psychiatrist, physician, clinical psychologist, or clinical social worker. Medicare usually does not provide coverage for family or couples 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. 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 it may limit you to those who are in-network. Each insurer will have its own criteria. Check 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 whether it covers 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.
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 organizations. Here are some tips:
