Does Medicare Cover Marriage Counseling?
Medicare Benefits Solutions
Sep 25, 2020
Did you know that Medicare may help cover the cost of counseling and therapy sessions? You probably know that Medicare covers many medical and diagnostic testing procedures.
But did you also know that Medicare provides coverage for mental health services? If you or your spouse are experiencing marital problems, Medicare Part B may pay a portion of your family and marriage counseling costs.
Marriage Counseling vs. Couples Therapy
Marriage counseling, which falls under the category of psychotherapy, can be insightful and empowering. The overall objective of this type of counseling is to fortify relationships through open communication and conflict resolution.
Top couple’s relationship issues include:
- Health problems
- Anger issues
- Substance abuse
- Domestic abuse
- Financial problems
- Conflicts with children
- Lack of communication
But is marriage counseling the same as couples therapy? Some people may say yes, but couples therapy typically refers to married or unmarried couples experiencing problems in their relationship. Marriage counseling on the other hand is usually for newly married couples or couples contemplating marriage.
Many therapists have graduate and postgraduate degrees such as Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPCS). 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.
TIP: Did you know that in addition to attending marriage counseling in a professional healthcare setting, such as a doctor’s office or community mental health center, you and your spouse may be able to attend virtual telehealth counseling sessions?
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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, Medicare 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 to 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.
TIP: Learn about the top 7 reasons why people choose to switch Medicare Advantage plans.
Part B Medicare Marriage Counseling 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. Medicare 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.
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Marriage Counseling Resources
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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