Does Health Insurance Cover Couples Therapy?
Wondering if health insurance covers couples therapy? Learn what types of therapy are covered, how insurance billing works, and tips to maximize your benefits for relationship counseling.
Couples therapy, also known as marriage counseling or relationship counseling, is a valuable resource for partners looking to improve communication, resolve conflicts, and strengthen their bond. But many people wonder: does health insurance cover couples therapy?
The answer is nuanced. Coverage depends on your insurance plan, the reason for therapy, and how your sessions are billed. In this comprehensive guide, we’ll break down everything you need to know about insurance coverage for couples therapy, including types of therapy, billing codes, plan types, and tips to maximize your benefits.
1. Understanding Couples Therapy
Before diving into insurance coverage, it’s important to understand what couples therapy is.
1.1 What Couples Therapy Is
Couples therapy is a form of psychotherapy designed to help romantic partners resolve conflicts, improve communication, and build stronger relationships. Licensed therapists use various approaches, including:
- Emotionally Focused Therapy (EFT): Helps couples understand and respond to each other’s emotional needs.
- Cognitive Behavioral Therapy (CBT): Helps partners recognize and change negative thought patterns.
- Gottman Method: Focuses on improving friendship, intimacy, and conflict management.
1.2 Goals of Couples Therapy
The main goals of couples therapy include:
- Improving communication skills
- Resolving conflicts
- Strengthening intimacy and emotional connection
- Addressing issues like infidelity, parenting disagreements, or financial stress
While therapy can benefit all couples, insurance coverage depends on whether the therapy addresses a diagnosable mental health condition.
2. Health Insurance and Mental Health Coverage
Health insurance plans often cover mental health services, but there are specific rules and limitations.
2.1 Mental Health Parity
In the U.S., the Mental Health Parity and Addiction Equity Act (MHPAEA) requires most insurance plans to provide mental health coverage comparable to medical coverage. This means your insurance should cover therapy for conditions like:
- Depression
- Anxiety
- PTSD
- Relationship stress linked to a mental health condition
However, the law does not require coverage for couples or marriage counseling if there is no medical diagnosis.
2.2 What Therapy Insurance Typically Covers
Most health insurance plans cover:
- Individual therapy sessions
- Family therapy sessions (sometimes including couples if there’s a diagnosed condition)
- Group therapy sessions
2.3 What Insurance Usually Does Not Cover
Insurance plans often exclude:
- Premarital counseling
- General relationship counseling without a diagnosis
- Life coaching or personal growth therapy
3. Does Health Insurance Cover Couples Therapy?
The short answer is: sometimes, but with conditions.
3.1 Coverage With a Mental Health Diagnosis
Insurance will often cover couples therapy if one partner has a mental health condition. For example:
- Partner A is diagnosed with depression.
- Therapy sessions focus on how relationship stress affects Partner A’s mental health.
- The therapist bills the session using a mental health diagnosis code (e.g., depression or anxiety).
In this case, insurance may cover a portion of the therapy cost.
3.2 Coverage Without a Diagnosis
If the couple seeks therapy solely for improving communication or resolving general conflicts without a mental health diagnosis, insurance usually does not cover the sessions.
3.3 Employee Assistance Programs (EAPs)
Some employers offer EAP benefits, which may include:
- Free or low-cost couples therapy sessions
- Confidential counseling services
- Short-term therapy (typically 3–6 sessions)
EAP benefits are often overlooked but can be a helpful way to access couples therapy without paying out of pocket.
4. How Insurance Billing for Couples Therapy Works
Therapists use CPT codes when billing insurance. The code affects whether the session is covered.
4.1 Common Codes
- 90837: Individual therapy, 60 minutes
- 90846: Family therapy without patient present
- 90847: Family therapy with patient present (can include couples therapy)
4.2 Medical Necessity Documentation
Insurance companies often require documentation showing medical necessity. Therapists need to:
- Include a mental health diagnosis
- Explain how therapy affects the patient’s condition
- Submit progress notes or treatment plans
Without proper documentation, insurance may deny the claim.
4.3 Out-of-Pocket Costs
Even if your insurance partially covers couples therapy, you may still pay:
- Copays (usually $20–$50 per session)
- Coinsurance (10–30% of session cost)
- Deductibles (if not yet met)
5. Types of Insurance Plans and Coverage
Coverage varies depending on your insurance type:
5.1 Employer-Provided Insurance
- Often includes mental health coverage with limited sessions.
- May require referral or pre-authorization.
- EAP benefits may provide additional free sessions.
5.2 Private Insurance
- Typically requires a mental health diagnosis for coverage.
- Some plans exclude marriage or relationship counseling entirely.
- Premiums vary depending on coverage limits.
5.3 Medicare and Medicaid
- Medicare covers therapy for individuals with mental health diagnoses.
- Couples therapy without a diagnosis is usually not covered.
- Medicaid coverage varies by state; some states may allow family or couples therapy if medically necessary.
6. Tips for Maximizing Coverage
If you want insurance to cover couples therapy, follow these tips:
- Check your plan: Review mental health benefits, coverage limits, and required documentation.
- Talk to your therapist: Ask if they can bill sessions under a mental health diagnosis for one partner.
- Use EAP benefits: Many employers offer free short-term couples counseling.
- Keep documentation: Save receipts, billing codes, and therapist notes for potential insurance appeals.
- Consider teletherapy: Online therapy platforms may offer lower-cost sessions with insurance reimbursement.
7. Alternatives If Insurance Doesn’t Cover Couples Therapy
If your plan doesn’t cover couples therapy, you still have options:
- Sliding scale therapy: Many therapists offer reduced fees based on income.
- Nonprofit organizations: Some community centers provide free or low-cost counseling.
- Online platforms: Websites like BetterHelp or Talkspace offer subscription-based couples therapy.
- Workshops and retreats: Focused programs on communication and relationship skills.
8. Key Takeaways
- Health insurance may cover couples therapy, but usually only if one partner has a diagnosed mental health condition.
- Pure relationship counseling without a diagnosis is rarely covered.
- Employee Assistance Programs (EAPs) can provide free short-term sessions.
- Proper documentation, billing codes, and therapist communication are crucial for maximizing coverage.
- If insurance doesn’t cover therapy, sliding scale options and online platforms are effective alternatives.
9. Conclusion
Couples therapy can be transformative, but navigating insurance coverage can be tricky. Understanding your plan, communicating with your therapist, and exploring alternative options can help you access therapy without breaking the bank.
If you’re committed to improving your relationship, don’t let insurance barriers stop you. Even a few sessions can make a meaningful difference.