Is Marriage Counseling Covered by Insurance?

It’s heartwarming to see more and more individuals recognizing the importance of addressing their relationship issues before they escalate and cause further damage.

However, I understand that not everyone has the means to afford private counseling services. That’s why many turn to a community mental health center and other institutions that offer mental health services at discounted rates for those in need.

Now, as a couples therapist, you may be wondering how you can make the most of insurance benefits to better serve your clients. And that’s a valid question.

So let’s dive in and explore this topic together, starting with the most crucial question of all.

Does Insurance Cover couples therapy?

While most insurance plans in the United States do not cover marriage counseling, some mental health policies can include coverage for relationship counseling if the need arises due to a diagnosable mental health condition.

According to the Affordable Care Act (ACA) and other insurance equity laws in the US, insurers must provide equitable coverage for mental health conditions.

Insurance laws don’t apply to marriage counseling because a health insurance plan only covers a medical diagnosis. Since the need for marriage counseling is not a medical diagnosis, it is not covered.

Then how is marriage counseling covered by insurance? Well, there are certain parameters under which insurance coverage can be obtained.

Ways to Get Insurance Benefits for Marriage Counseling

How can the insurance cover marriage counseling? Here are 3 ways you can:-

Health Insurance Coverage

The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires health insurance companies to provide equal coverage for mental health and substance use disorder (SUD) treatment as they do for medical and surgical treatment.

This means that individuals can seek relationship counseling for a mental illness, in which case the health insurance company can allow for coverage.

The specifics of coverage can vary depending on the plan and the insurance company:-

  • Some plans may cover only a limited number of sessions, while others may cover an unlimited number of sessions.
  • Some plans may require pre-authorization or a referral from a primary care physician before covering couples counseling.

But most importantly, the health insurance provider will only cover couples counseling expenses if you accept a mental health diagnosis like:-

  • Anxiety
  • Depression
  • Bipolar disorder
  • Schizophrenia
  • PTSD

These are just to name a few but once the individual makes a claim for a diagnosed mental health disorder, the therapist will be paid by the insurance company.

It’s also important to note that the health insurance industry offers 2 forms of insurance plans:-

Traditional Health insurance

  • Traditional health insurance, on the other hand, is a comprehensive health insurance policy that covers a wide range of medical services and treatments.
  • These policies are usually more expensive than short-term health insurance and require a higher monthly premium.
  • They typically cover preventive care, prescription drugs, mental health treatment, and pre-existing conditions.

Short-term health insurance

  • Short-term health insurance policies are designed to provide temporary health coverage for individuals and families who need coverage for a short period, typically less than 12 months.
  • These policies are usually less expensive than traditional health insurance plans and have fewer benefits.
  • They may not cover pre-existing conditions, preventive care, or mental health treatment.

Employee Assistance Programs

An Employee Assistance Program (EAP) is a benefit offered by many employers that provides confidential counseling, support, and resources for employees and their families.

The purpose of an EAP is to help employees manage personal and work-related issues that may affect their emotional, mental, and physical well-being.

If an individual is working under someone, they can utilize the EAP provided by their employer. Here are 3 things you should know about the employee assistance program:-

  • It’s voluntary, so you must avail it as an option with your employer first.
  • It’s confidential, so no one (including the HR department or your manager) will have access to your usage of it.
  • While plans differ from company to company, every plan offers at least 5 free marriage counseling, even family therapy sessions every year. However, it’s always wise to check with your employer’s employee assistance program.

Medicare Part B

Medicare is a federal health insurance program that provides coverage for people aged 65 and older, as well as those with certain disabilities or end-stage renal disease. The program has 3 parts, each of which covers different services and expenses.

The part that’s relevant to individuals seeking marriage counseling isMedicare Part B, which covers medical necessity services, i.e services where a person needs diagnosis or treatment for their medical condition that meets accepted medical practice standards.

It covers mental health conditions claiming that they can apply for family therapy. It means they can avail counseling from professionals like:

  • Clinical psychologist
  • Licensed Clinical social worker
  • Clinical nurse specialist
  • Psychiatrist
  • Physician Assistant
  • Nurse practitioner

Insurance companies don’t cover Marriage and family therapists, so if you need an MFT, you’ll have to pay out of pocket.

How Much Do Marriage Counselors Earn?

Marriage Counseling typically has a similar cost to individual therapy, although some therapists can charge more for working with couples.

The fees charged by couples therapists are not regulated. Also, the cost depends on factors like

  • location
  • experience and credentials of the marriage counselor
  • the type of therapy being used

Based on the reports published by the Bureau of Labor Statistics (BLS), the average salary earned by Marriage and Family therapists in the year 2021 was estimated to be $59,660, with the median income in May 2021 being $49,880.

This suggests that half of the marriage counselors in the United States earned an income higher than the median value.

However, the lowest-paid 10 percent of MFTs, which includes entry-level therapists working in lower-paying states, earned a salary of $37,050, while the top 10 percent, which includes the highest-paid marriage therapists/counselors, earned upwards of $96,520.

For example, in the US, the cost of couples therapy can range anywhere between $75 to $250 per hour. Now, because this varies depending on the location, it means couples therapy may cost more in urban areas with a higher cost of living than in rural areas.

How Much Does It Cost With Insurance?

Usually, all you have to pay out of pocket in most cases is something called a copay.

Copay

A copayment, also known as a copay, is a fixed amount that a patient is required to pay out-of-pocket for a covered healthcare service at the time of the visit.

The copay amount varies depending on the specific service and the insurance plan, and it is typically a set dollar amount, such as $20 or $30 per visit.

Copays are a way for insurance companies to share the cost of healthcare services with patients, and they are usually outlined in the insurance policy or summary of benefits.

The copay is paid by the patient directly to the healthcare provider at the time of the visit, and it is not applied to the patient’s deductible or out-of-pocket maximum.

Cost under EAP

Generally, there is no copay required for counseling or therapy sessions provided through an Employee Assistance Program (EAP). EAPs are often offered as a free benefit by employers to their employees and their family members.

Typically, EAPs provide a set number of free marriage and family therapy sessions to their employees to address issues such as anxiety, depression, relationship problems, and stress management. The exact number of sessions and the scope of issues covered by an EAP may vary depending on the specific plan offered by your employer.

Cost Under Health Insurance

Whether you have to pay a copay under your health insurance plan, and how much you have to pay, will depend on the specific details of your insurance provider.

A copay is a fixed amount you pay for a covered service at the time you receive it. Copays vary depending on the service and your insurance plan, but they are typically in the range of $10-$50 per visit.

Some health insurance plans have deductibles, which is the amount you have to pay out-of-pocket before your insurance starts paying for services. Once you’ve met your deductible, you may still have to pay a copay for each visit, but your insurance will pay the remaining cost of the service.

Cost Under Medicare Part B

This part of Medicare covers doctor visits, outpatient care, preventive services, and some medical equipment.

There is a monthly premium for Part B, which is $170.10 in 2022 for most people, but it can be higher depending on your income.

You will also be responsible for an annual deductible of $233 in 2022, and then you will typically pay 20% of the Medicare-approved amount for most services.

Therapists Covered by the Insurance Companies

In case you didn’t know, individuals seeking couples therapy can’t just ask for insurance coverage to go visit any clinical psychologist that they like. It doesn’t matter if they’re licensed, or not.

The insurance companies verify each marriage counselor, and after they get qualified, they are allowed to be in their network of therapists, which means that if any insuree makes a claim for availing counseling services, the therapists within their network are the only ones the insuree can avail therapy sessions from.

These therapists are called in-network providers.

Out-of-Network vs In-Network Providers

In-network and out-of-network therapists differ in their relationship with insurance companies.

In-Network Provider

An in-network therapist has a contract with an insurance company to provide services at a negotiated rate. This means they have agreed to accept the insurance company’s reimbursement rate for their services and are subject to their rules and regulations.

Patients who see an in-network therapist usually pay a lower out-of-pocket cost than they would for an out-of-network therapist.

Out-of-network provider

On the other hand, an out-of-network therapist does not have a contract with an insurance company. Patients who see an out-of-network therapist may have to pay more out-of-pocket costs for their services.

They may need to pay the full cost upfront and then seek reimbursement from their insurance company. The reimbursement rate for out-of-network therapists is typically lower than for in-network therapists, and the patient may have to pay a higher percentage of the cost.

Benefits of Choosing an In-Network Provider

Cost

In-network providers typically have negotiated rates with insurance companies, which can result in lower costs for patients.

Patients may be required to pay a copay or coinsurance for each session, but these costs are typically lower than what they would pay for out-of-network providers.

Out-of-network providers may charge higher fees, and patients may need to pay more out-of-pocket costs.

Access

In-network providers are often easier to access because they are part of an insurance company’s network.

Patients can search for in-network providers on their insurance company’s website or by calling the customer service number.

Out-of-network providers may be more difficult to find, and patients may need to do more research to find a provider who meets their needs.

Reimbursement

Insurance companies typically reimburse in-network providers at a higher rate than out-of-network providers.

This means that in-network providers receive a set amount for their services, while out-of-network providers may need to negotiate reimbursement rates with insurance companies.

Patients who see out-of-network providers may need to submit claims for reimbursement to their insurance company, which can be a time-consuming process.

Provider qualifications

Insurance companies typically require in-network providers to meet certain qualifications, such as licensing and accreditation. These requirements help ensure that providers meet certain standards of care.

Out-of-network providers may not have these qualifications, which can make it more difficult for patients to assess the quality of their care.

How to Become an In-Network Provider?

Find the right insurance companies

Research the insurance companies you are interested in becoming an in-network provider for. Look at their provider directories to see what types of therapists they currently work with and what areas of therapy they cover.

Apply to become a provider

Once you have identified the insurance companies you want to work with, you can apply to become an in-network provider. This typically involves submitting an application, providing proof of your qualifications and credentials, and completing any required training.

Negotiate rates

Once accepted as an in-network provider, you may need to negotiate your reimbursement rates with the insurance company. This can involve discussing your fees, the services you offer, and the volume of patients you expect to see.

Maintain your credentials

To remain an in-network provider, you must maintain your credentials and stay up-to-date with any changes in insurance policies or regulations. This may involve completing continuing education courses, renewing your license or certification, and regularly reviewing your contracts with insurance companies.

Sign up for our email newsletter.

Enter your details to receive the latest news from Terry straight to your inbox. You’re about to access: