Does Medicare Cover Marriage Counseling?

More than 1 in 5 Americans have sought marriage counseling to manage issues in their relationships. 

People may use these services once they’ve retired and their children leave home. Although quality time is essential to nurture relationships, spouses often have to adjust to spending more time together than ever before. Tension and difficulties can develop.

If you need help during this transition, you may wonder is marriage counseling covered by insurance like Medicare. 

What Kind of Counseling Does Medicare Pay For?

Medicare does not explicitly cover marriage counseling. However, if marriage problems impact your mental health, Medicare covers counseling services to help treat those mental health issues.

You can speak with your doctor about depression, anxiety and other mental health issues at any time of the year, but a depression screening is included for free as part of your Medicare annual wellness visit. In any case, your doctor can assess your psychological wellbeing, and if necessary, they'll refer you to a counselor.

Medicare Part B covers most mental health and family counseling that you’d receive in an outpatient setting, while Medicare Part A covers inpatient counseling for people who require full or partial hospitalization. Medicare Advantage (Medicare Part C) plans provide at least the same level of coverage, and some MA plans may offer more counseling benefits than Original Medicare (Medicare Parts A and B).

Outpatient counseling is the most common option for people with marriage concerns. Medicare covers mental health counseling with the following health professionals provided they accept Medicare assignment:

• Psychiatrist or another doctor
• Clinical psychologist
• Clinical social worker
• Clinical nurse specialist or nurse practitioner
• Physician assistant 

You may have one-on-one counseling, family counseling with a spouse, group therapy or a combination of these if your doctor deems it medically necessary in the treatment of mental illness.

Medicare does not cover counseling therapists if they are solely licensed as Marriage and Family Therapists (MFTs). Medicare also doesn’t cover counseling from non-licensed professionals, such as members of the clergy.   

Counseling for mental health is just one of the forms of counseling that Medicare covers. Other types of counseling may be helpful if specific issues are impacting your relationship. 

Medicare Part B may cover counseling to help you with: 

• Grief and loss
• Sexual habits that put you at high risk of a sexually transmitted infection
• Weight loss
• Quitting smoking
• Alcohol misuse and/or substance abuse

How Many Therapy Sessions Does Medicare Pay For?

Medicare Part B covers unlimited counseling sessions to manage your mental health. Once you meet your Part B deductible, Medicare typically pays 80% of your allowable charges for as many therapy sessions as you need. Deductibles, copays and coinsurance amounts may apply.

 If you require alcohol misuse counseling, Medicare only covers four sessions. Keep this in mind if you’re using these counseling sessions to improve your relationship.

Does TRICARE for Life Cover Marriage Counseling?

TRICARE for Life is a health care program for current and former military service members and their families that enhances their Medicare coverage. It does not specifically cover marriage counseling, but like Medicare, it covers counseling for mental health.  

If you or your spouse has depression, post-traumatic stress disorder, adjustment issues or other mental health problems, counseling may help. It could be one-on-one or family counseling. 

TRICARE for Life members must use in-network authorized counseling providers. You'll pay your Medicare Part B premiums, but there are no other costs to access counseling through TRICARE for Life in most cases.

Does Medicaid Cover Marriage Counseling?

Medicaid subsidizes the cost of marriage counseling in around 38 states. The level of coverage for couples therapy varies from state to state and between the various Medicaid plans. 

You may have coverage for counseling from any marriage and family therapist, or this may be limited to clinic and institutional settings. Conversely, some Medicaid programs don’t cover this form of therapy. 

However, as with Medicare, Medicaid usually covers counseling to improve mental health. You might discuss your marriage during these counseling sessions. Check your Medicaid provider manual to check which marriage counseling services, if any, are available with your plan.

How Can You Find a Marriage Counselor Covered by Medicare?

You can review your Medicare documents to learn about the types of counselors your plan covers. You may be limited to using an in-network counseling provider. Insurance companies often list these approved counselors on their websites. You could also call your insurance company or health insurance agent for recommendations.

If you aren’t subject to network restrictions, you have more options, which may include:

• Asking your doctor to suggest local counselors who could help
• Looking online for reviews and feedback on specific counselors
• Using the online therapist finder of the American Association of Marriage and Family Therapy
• Talking with friends who’ve had marriage counseling and asking for their details
• Provider websites can also help you determine whether a counselor is a good fit for you

Remember to call your preferred provider and check if they accept Medicare assignment before making an appointment.

Medicare Can Help Support Your Mental Health

Problems in your marriage can significantly impact your health and wellbeing, but Medicare is there to help. 

If these problems affect your mental health, counseling can help you navigate these challenges and improve your relationship and wellbeing.

Medigap Plans and Marriage Counseling Surgery

Medigap plans (also called Medicare Supplement) don't typically cover health services such as mental health counseling. If your counseling services are covered by Medicare, however, a Medigap plan could help you save money on the out-of-pocket Medicare costs for your surgery. Medigap plans work alongside your Original Medicare coverage to help fill in the "gaps" of Medicare deductibles, coinsurance, copays and more.

As mentioned above, you're typically responsible for 20% of the Medicare-approved amount if your counseling is covered by Medicare. This 20% copay could add up quickly. A Medigap plan that covers your Medicare Part B coinsurance would pay for those costs.

Call to speak with a licensed insurance agent to learn more about how a Medigap plan could help you pay for your Medicare-covered counseling services, as well as other Medicare out-of-pocket costs. You can also compare plans online for free, with no obligation to enroll.