Does Medicare cover marriage counseling

Relationships take work, and sometimes that means seeking outside help through marriage counseling or couple therapy. But for older adults or those with disabilities who rely on Medicare, one common question is: does Medicare cover marriage counseling? The answer isn’t always straightforward. While Medicare does provide support for mental health services, marriage counseling isn’t always fully covered. 

Let’s dive into the specifics so you can better understand your options, eligibility, costs, and alternative paths to healing your relationship, even if Medicare doesn’t meet your needs. 

 

Does Medicare cover marriage counseling? 

In short, Medicare typically does not cover marriage counseling when it’s solely focused on relationship issues. However, there are exceptions. 

Medicare Part B covers mental health services, including psychotherapy, family counseling, and behavioral health therapy, but only when it is deemed medically necessary. That means the counseling must treat a mental health condition such as sadness, anxiety, or PTSD. So, if a couple seeks therapy primarily for communication problems, conflict resolution, or general relationship improvement, those services are usually not covered. 

However, if a therapist is addressing a diagnosed mental health issue and involves a spouse or partner in therapy as part of a treatment plan, Medicare may cover part of the costs. 

 

When does Medicare provide coverage for marriage or couples counseling? 

Medicare will provide partial coverage for marriage or couples counseling when: 

• One partner is diagnosed with a mental health disorder, such as significant depressive disorder or generalized anxiety disorder. 

• Counseling is part of the treatment for the diagnosed condition. 

• The therapy is provided by a Medicare-approved provider, such as a clinical psychologist, psychiatrist, or certified clinical social worker. 

• The focus of the session is the diagnosed individual’s care, not the relationship itself. 

So, does Medicare cover marriage counseling for relationship enhancement alone? Unfortunately, no. But if it’s related to a larger mental health treatment plan, then yes, it might. 

 

What types of therapy or mental health counseling are eligible under Medicare? 

Medicare Part B covers outpatient mental health benefits, which include: 

• Individual psychotherapy 

• Family counseling (when it helps with the patient’s treatment) 

• Group therapy 

• Annual depression screenings 

• Diagnostic tests 

• Medication management 

These services must be provided by professionals who are authorized by Medicare and are typically covered at 80% of the approved amount after the Part B deductible is met. 

 

What kinds of licensed counselors or therapists can provide covered services? 

Not all mental health professionals are eligible to bill Medicare. Covered providers include: 

• Psychiatrists 

• Clinical psychologists 

• Clinical social workers 

• Nurse practitioners or physician assistants (if they provide psychotherapy) 

• Licensed professional counselors (LPCs) and marriage and family therapists (MFTs) (starting in 2024, according to the Medicare final rule update) 

If you’re seeing someone for therapy, make sure they’re enrolled in Medicare and eligible to provide services under your plan. Otherwise, even if your treatment qualifies, it won’t be covered. 

 

How much does marriage counseling cost if Medicare provides partial coverage? 

If Medicare does cover your counseling as a segment of a mental health treatment program, you can expect to pay: 

• 20% of the Medicare-approved amount for each session (after the deductible) 

• The Part B deductible, which is $240 in 2024, must be met before Medicare pays its share 

• If you have a Medigap (Medicare Supplement) plan, it may aid cover the 20% coinsurance 

It’s also worth checking with your therapist’s office to see if they accept Medicare assignment, which means they agree to Medicare’s approved payment rates. 

 

How can family therapy help in cases where Medicare may not cover couples counseling?  

If traditional marriage counseling isn’t covered, you might still benefit from family therapy, which Medicare may approve as part of a mental health treatment plan. In these sessions: 

• The spouse participates in therapy to support the patient’s recovery 

• The therapist focuses on how family dynamics affect the patient’s health 

• Sessions are goal-oriented and based on the mental health diagnosis, not just relationship repair 

While it’s not the same as marriage counseling, it can still provide valuable tools to enhance communication and alleviate emotional strain in a partnership. 

 

What is the typical cost of marriage counseling without Medicare or insurance? 

If you’re paying out-of-pocket, marriage counseling can vary from $75 to $250 per session, depending on: 

• The provider’s credentials 

• Location 

• Session length 

• Type of therapy used 

Some therapists propose sliding scale fees based on income, so it’s worth asking if that’s an option. Additionally, many couples report needing 8 to 20 sessions, depending on the depth of the issues, so that the cost can add up quickly. 

 

Does any health insurance plan, including Medicare Advantage, cover marriage counseling? 

Some Medicare Advantage (Part C) plans may offer broader mental health benefits than Original Medicare. Private insurance companies propose these plans and often include: 

• Additional therapy sessions 

• Wider range of providers 

• Telehealth options 

• Lower out-of-pocket costs 

Check the plan details carefully. Even with expanded benefits, many Medicare Advantage plans still limit coverage to therapy for diagnosed conditions. However, some may offer behavioral health programs that address relationship wellness. 

If you have employer-sponsored retiree health benefits or a private plan, contact your insurer to determine what’s included under behavioral health or Employee Assistance Program (EAP) services. 

 

What are your options for marriage counseling without health insurance?

If Medicare or private insurance won’t cover it, you still have options: 

• Community mental health centers: Often offer low-cost or sliding-scale couples counseling. 

• University clinics: Graduate students in counseling programs offer therapy under supervision at reduced rates. 

• Faith-based organizations: Many offer free or donation-based counseling to members. 

• Online therapy platforms: Sites like BetterHelp and ReGain offer more affordable virtual couples counseling. 

Don’t let cost stop you from getting help. Many people find affordable options by asking local providers about payment plans or low-income assistance programs. 

 

What types of marriage counseling approaches are available? 

If you’re new to therapy, here are some popular approaches that couples try: 

• Emotionally Focused Therapy (EFT): Helps couples understand emotional responses and build secure attachment. 

• Gottman Method: Uses evidence-based techniques to improve communication and manage conflict. 

• Cognitive Behavioral Therapy (CBT): Focuses on changing negative thought patterns. 

• Imago Relationship Therapy: Encourages deeper understanding of emotional wounds from childhood. 

• Solution-Focused Brief Therapy (SFBT): Focuses on current problems and quick strategies to move forward. 

Each couple is different, and what works for one might not work for another. A good therapist will help find the right fit for your situation. 

 

Is marriage counseling worth it even if it’s not covered by Medicare? 

Absolutely. While the financial burden can be real, especially if Medicare doesn’t cover marriage counseling, many couples find the investment in therapy worthwhile. Marriage counseling can: 

• Improve communication 

• Resolve lingering conflicts 

• Rebuild trust 

• Increase emotional intimacy 

• Support mental health recovery 

For couples on the brink, it can even be the turning point that prevents divorce or years of unresolved tension. 

If you’re struggling in your relationship and wondering does Medicare cover marriage counseling, the most critical step is to start the conversation with your provider, your partner, and your healthcare team. Even if coverage is limited, there are still possibilities to get the support you need. 

 

Final Thoughts 

Medicare may not be your golden ticket to free couples counseling, but understanding what it does and doesn’t cover can help you make smarter, more empowered decisions. Mental health is deeply intertwined with relationship health. While Medicare’s coverage is primarily clinical, your path to healing doesn’t have to stop there. 

Disclaimer: This article is for informational purposes only. Medicare coverage and costs can vary by region, plan type, and individual circumstances. Always speak directly with your provider or Medicare representative for the most accurate information.

Source: healthcare.gov