Does Medicare Cover Marriage Counseling?

In this article...
  • Marriage counseling helps some couples struggling with relationship challenges. Determining if Medicare covers it can help you know if its an option.

Medicare provides insurance and financial assistance to qualifying individuals over the age of 65 and those with disabilities. Those with Medicare Advantage programs may have more options for therapy, depending on their plan selection. 

But what about mental health services, such as counseling? For example, for couples struggling with marital issues, marriage counseling can help to overcome obstacles threatening to derail the relationship. But does Medicare cover marriage counseling?

How Does Marriage Counseling Work?

As is the case with any form of counseling, marriage counseling is specific to the couple that needs it. Successful approaches may vary between couples, as some need more intensive therapy than others. 

Traditionally, marriage counseling starts with a session in which both parties express why they feel they do or do not need the assistance. The counselor will assess the core issues with which the couple is struggling. He or she then creates a therapeutic plan to help the couple work on fixing the problem or recommend other measures, such as individual counseling. 

Does Medicare Cover Marriage Counseling?

Medicare does cover marriage counseling with certain caveats. It falls under the coverage provided by Medicare Part B as long as the therapy is provided by a licensed psychiatrist, clinical psychologist, clinical social worker, physician or nursing specialist. 

Part B does not offer provisions for marriage counseling for licensed marriage and family therapists (LMFTs). The only exception is for those who are part of a clinical construct, such as an office run by a clinical psychologist, mental health facility or hospital. In these cases, Medicare may allow for counseling if someone from the eligible practitioner categories is present for the sessions. 

Because Medicare Advantage programs replace Parts A and B entirely, they may offer more options for marriage therapy than the original components of the program. When asking does Medicare cover marriage counseling, those with Medicare Advantage should review the terms of their plan to make this determination. 

What Other Components of Mental Health Care are Covered by Medicare?

Marriage counseling may sometimes be necessary if one or both parties in the marriage are struggling with other mental health issues. As such, other mental health services are provided under Medicare Part B: 

  • Annual depression screening
  • Individual psychotherapy with a licensed professional
  • Family counseling (to assist with a larger treatment plan)
  • Mental health testing
  • Psychiatric evaluation services
  • Diagnostic testing for psychiatric purposes
  • Inpatient psychiatric services
  • Some prescription medication for mental health
  • An initial assessment for mental health

Costs

Medicare covers a yearly depression screening by a healthcare provider for no out-of-pocket cost, which may be a requirement for marriage counseling to determine if other issues are contributing to the marital issues.

For additional counseling services, Medicare pays 80% of the cost, leaving Part B beneficiaries with 20% of the financial responsibility. Those with a Medigap plan may have assistance with the remaining 20% as these plans are meant to pick up financially where Medicare leaves off in terms of coinsurance, copays and deductibles. 

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