Does Medicare Cover Marriage Counseling?

Medicare is a federal health insurance program for individuals aged 65 or older, younger people with certain disabilities, and those with End-Stage Renal Disease. Many people wonder about the extent of Medicare’s coverage, particularly concerning mental health services like marriage counseling.

Medicare’s Approach to Mental Health Coverage

Medicare Part B covers a range of outpatient mental health services. These services are typically provided in settings such as a doctor’s or therapist’s office, hospital outpatient departments, or community mental health centers. For coverage, these services must be deemed “medically necessary,” meaning they are reasonable and essential for diagnosing or treating an illness or injury, and they must meet accepted standards of medical practice.

Covered mental health services under Medicare Part B include individual and group therapy, diagnostic evaluations, and medication management. Patients can also receive annual depression screenings without a co-payment if provided by a primary care doctor who accepts Medicare assignment. Services must be furnished by a licensed professional who accepts Medicare assignment, such as a psychiatrist, clinical psychologist, clinical social worker, or, as of January 1, 2024, a licensed marriage and family therapist or mental health counselor. After meeting the annual Part B deductible, beneficiaries pay 20% of the Medicare-approved amount for covered mental health services.

Coverage for Marriage Counseling

Medicare does not cover marriage counseling, as its primary focus is on treating an individual’s specific medical or mental health condition. Marriage counseling addresses relationship dynamics between two people rather than a diagnosable mental illness in one individual. Since relationship issues are not classified as a mental health diagnosis, they do not meet Medicare’s “medically necessary” criteria for coverage.

There is a narrow exception where Medicare might cover a portion of a session that includes a spouse or family member. This occurs only if the presence of the spouse or family member is considered integral to the treatment of a specific, diagnosable mental health condition of the Medicare beneficiary. For example, if a therapist determines that a spouse’s participation is crucial for the beneficiary’s individual therapy for depression, that specific part of the session may be covered. The central focus must remain on the Medicare beneficiary’s individual treatment plan, not on general couples’ therapy for relationship improvement.

Exploring Other Options for Relationship Support

Given that Medicare does not cover marriage counseling, individuals and couples need to explore alternative avenues for support. Private health insurance policies may offer coverage for couples therapy, though it requires one partner to have a diagnosable mental health condition for which the therapy is considered medically necessary. It is important to review specific policy details to understand potential benefits.

Employee Assistance Programs (EAPs), offered by many employers, provide free and confidential short-term counseling, referrals, and resources for various personal and work-related issues, including relationship challenges. Community mental health centers offer services on a sliding scale based on income, making therapy more affordable for those without extensive insurance coverage. University training clinics, which operate with lower fees, and private pay options, including online therapy platforms, also provide accessible ways to seek relationship support.