Does Medicare Cover Marriage Counseling? 

Marriages and relationships can be challenging at any age. If you’ve reached retirement age, you might be going through a lot of life changes now, and some might be affecting your marriage. You shouldn’t feel like you’re alone. It’s common for couples to experience rocky patches throughout their married lives, and those in their golden years often seek marriage counseling for help.  

Statistics gathered in the United States show that couples in long-term marriages of 25 years or more often seek marriage counseling because they are experiencing the following types of issues:

• Transitioning from a busy career to retirement
• Health problems that can take a toll on a close relationship
• Lack of intimacy, loss of desire for a sexual relationship
• Deciding not to get a divorce and to stay together
• Loss of connection and growing apart from each other
• Infidelity

Maintaining a strong marriage and a good relationship with your spouse doesn’t end at retirement, and getting professional help from a qualified marriage counselor might be just what you need to get back on track. 

Does Medicare cover marriage counseling? 

Original Medicare Part B(medical insurance) covers family counseling for those who qualify as part of its outpatient mental health care benefits. Because marriage counseling is a form of family counseling, you can get coverage if your health care provider certifies that you need it because it will help with the treatment you are receiving for a mental health issue like depression or anxiety. 

Medicare Part B will cover its share of the expense for your counseling if you see a health care professional that accepts Medicare assignment. Eligible health care professionals include:  

• Psychiatrists 
• Clinical psychologists 
• Physicians
• Clinical social workers 
• Clinical nurse specialists 
• Nurse practitioners 
• Physicians’ assistants 

Finally, to be eligible for Part B coverage, you must have your counseling sessions in a facility that also accepts Medicare assignment. Eligible facilities include:

• The office of the qualified health care professional providing the counseling sessions 
• A hospital outpatient department  
• A community mental health center 
• Via telehealth counseling 

If you qualify for family (marriage) counseling, Original Medicare Part B will pay 80 percent of the final cost after Medicare approves it. Beneficiaries are responsible for paying the remaining 20 percent after they’ve met their annual Part B deductible. 

Does a Medicare Advantage plan cover marriage counseling?

Medicare Advantage (Part C) plans are required by law to cover, at minimum, the same benefits that Original Medicare Parts A and B do, so if you qualify for family counseling, your provider must cover it. 

The type of Medicare Advantage plan you’ve enrolled in determines the type of coverage you have. If your plan uses a set network of approved health care providers and medical facilities, you won’t have coverage if you use providers outside of this network. Contact your Medicare Advantage provider for more information if you aren’t sure who you can use for your health care, or if you aren’t certain about copayment or coinsurance charges. 

How much does marriage counseling cost without Medicare insurance? 

Costs for marriage counseling vary across the country based on the therapist’s qualifications, how often the sessions are, and how they are delivered. Today in the United States, the national average cost for an in-person marriage counseling session is between $50 and $200 per hour. Most counselors suggest that couples have at least one session per week for around three months total.