Does Medicare cover marriage counseling?

Medicare pays to diagnose and treat illness. A rocky marriage is not an illness. So counseling that only works on the relationship is not covered.

Medicare can pay for family psychotherapy. That is therapy where a spouse or other family member joins in to help treat the patient's mental health condition. Medicare's own words: family counseling is covered "if the main purpose is to help with your treatment."

• Covered: your spouse joins your sessions so your therapist can see how you two talk, and help with your depression or anxiety at home.
• Covered: a spouse meets the therapist, with or without you, to learn how to help manage your condition.
• Not covered: sessions to fix fights, trust or communication when neither person is being treated for a condition.

In short: the sessions must be part of treating a patient's mental health condition. The marriage can be part of the work, but it cannot be the reason for it.

Medicare contractors spell out when family sessions are covered. The tests are:

• The patient has a mental illness, or emotional or behavior symptoms bad enough to cause real problems in daily life.
• The main purpose is to treat or manage that patient's condition.
• The sessions are part of an active treatment plan tied to the patient's diagnosis.
• The provider writes down why each session is needed.

A "family member" can be a spouse, partner or caregiver. It means someone who spends a lot of time with the patient and gives emotional support. The patient does not have to be in the room for every session.

Since January 1, 2024, Medicare pays licensed marriage and family therapists and mental health counselors.

The therapist must be licensed in your state and enrolled in Medicare. They must accept assignment, which means they take Medicare's approved amount as full payment. They are not paid for care while you are a hospital inpatient.

You can also get family sessions from psychiatrists, psychologists, clinical social workers and other providers Medicare pays for mental health care. Video visits count too.

If the sessions are covered, you first meet the $283 Part B deductible for 2026. Then you pay 20% of the Medicare-approved amount. Medicare pays the rest. A hospital clinic may add its own copay.

• If you have a Medigap plan: every plan pays some or all of your 20% share.
• If you have Medicare Advantage: your plan sets its own copays. Check your plan's Evidence of Coverage.
• If you have Medicaid too: Medicaid may pay your share. Ask your state Medicaid office.

If the counseling is only for the relationship, Medicare pays nothing. You pay the therapist's full fee.

1. Start with the partner who has Medicare and a mental health concern. Their doctor or therapist does an evaluation first.
2. Ask if family sessions belong in the treatment plan. The plan should say how the sessions help treat the condition.
3. Pick a therapist enrolled in Medicare. Ask if they accept assignment.
4. Ask before you start if Medicare will cover it. If they think it will not, they may ask you to sign an Advance Beneficiary Notice. Signing it means you agree to pay if Medicare says no.
5. If a claim is denied, appeal. Your Medicare Summary Notice explains how.

In short: go through the Medicare patient's own mental health care, and have the treatment plan explain why family sessions are needed.