Does Medicare cover marriage counseling?

By Medicare Benefits - September 25, 2020

Marriage counseling, which falls under the category of psychotherapy, can be insightful and empowering. The overall objective of this counseling, which is also known as couples therapy, is to fortify relationships through open communication and conflict resolution. Many therapists have graduate and postgraduate degrees. Membership in the American Association for Marriage and Family Therapy (AAMFT) offers further education, training and resources. When interviewing practitioners, the Mayo Clinic suggests asking if they are credentialed by the AAMFT.  

Medicare coverage for counseling
Part B is the medical branch of Medicare coverage. In addition to doctor office visits, home health services and durable medical equipment, Part B covers outpatient services and mental healthcare. Along with depression screening, psychotherapy, psychiatric evaluation, diagnostic tests and certain medications, mental healthcare coverage as an outpatient includes family counseling with the primary objective being help with treatment. In some cases, the need for family counseling goes hand in hand with treatment for substance abuse or domestic violence, for example, which impacts the family dynamic.  

Marriage counseling would fall under the domain of family counseling. The counseling sessions may take place in the healthcare practitioner's office, a hospital outpatient unit or a community center for mental health. Though marriage counseling is typically administered by marriage and family therapists, the Medicare site does not address coverage for these counselors. Covered Medicare-eligible practitioners include psychiatrists or other doctors, nurse practitioners and physician assistants along with clinical psychologists, nurse specialists and social workers. 

Part B Medicare benefits
For Medicare-approved expenses under Part B, expect to pay the deductible and then 20% of the Medicare-approved amount as long as the doctor accepts assignment. Assignment is when the doctor agrees to accept payment directly from Medicare and not bill the patient for any amount above the deductible and coinsurance. For 2020, the Part B deductible is $198 for the year. 

A clinician's charges for therapy will vary based on such factors as credentials, location and the specific treatment plan. Since marriage therapy is typically conducted on a weekly basis, the cost can add up. It may be worth inquiring if the practitioner offers the option of charging on a sliding scale based on income.

If you are planning to go to couples therapy and find that Medicare will not approve it based on the setting or the therapist you choose, you may have another recourse if you or your spouse are working and covered by the employer's group health plan. Many group plans offer an employee assistance program that covers a portion of the cost under certain circumstances, such as when issues are related to depression or addiction. Research all your options so you can decide on the best approach.

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