Mediare Coverage for Marriage Counseling

Medicare covers marriage counseling and couples therapy only when it’s deemed medically necessary to treat a mental health condition (like anxiety or depression). 

Understanding how Medicare coverage works for marriage or couples counseling can be tricky at times. We’re here to break it down for you, and to help you find a qualified therapist who accepts Medicare.

Key takeaways

• To qualify for Medicare coverage, marriage or couples counseling must be part of treatment for a diagnosed mental health condition such as anxiety or depression.
• Medicare Part B covers marriage counseling/couples therapy. You can also use your Medicare Part C (Medicare Advantage) benefits.
• Since 2024, licensed therapists, licensed clinical social workers, psychologists, and others are approved Medicare providers for marriage counseling. 

Understanding when Medicare covers marriage counseling

Medicare Part B covers outpatient mental health services. These are services that take place outside of a hospital setting, such as a therapist’s office or via telehealth. Marriage counseling is included as a covered outpatient mental health service only when the therapist determines it’s medically necessary as part of treatment for a mental health condition.

This means Medicare doesn’t cover couples counseling for the sole purpose of strengthening your relationship or working through issues you might have with your partner. But Medicare does recognize that couples therapy may be necessary when a mental health condition is impacting the relationship, or when relationship problems contribute to symptoms of a mental health condition.

Besides marriage and family counseling, Medicare Part B therapy services may include:

• Psychiatric evaluations
• Diagnosis of mental health conditions
• One-on-one “talk therapy” or group therapy
• Medication management
• Safety planning interventions
• Annual depression screenings
• Alcohol misuse screenings and counseling
• Opioid use disorder treatment services

Therapist eligibility for marriage counseling

There are several different types of providers who are eligible to provide couples therapy under Medicare Part B. These include:

• Psychiatrists
• Doctors (MDs and DOs)
• Clinical psychologists
• Clinical social workers
• Nurse specialists and nurse practitioners
• Physician assistants
• Mental health counselors
• Marriage & family therapists

Previously, marriage and family therapists weren’t eligible to accept Medicare insurance for their services. But that changed in 2024 when Medicare recognized Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) as Medicare providers.

That move opened up more opportunities for people on Medicare to receive marriage counseling or couples therapy by highly experienced individuals trained specifically in this kind of care.

However, it’s important to note that Medicare has some special requirements for any MFT or MHC who provides services under Medicare:

• Licensed in a state to practice as an independent therapist
• Master’s degree or doctorate, and qualifying for licensure
• Minimum two years of clinical supervised experience and training in marriage and family therapy
• No interns, students, or associates

MFTs and MHCs can offer their services in private practice settings and in clinical settings.

Telehealth services for couples counseling

Another piece of good news: MFTs and MHCs are allowed to provide telehealth mental health services. This means you may be able to receive couples therapy in the privacy of your own home. To be eligible, the provider must be licensed in and reside in the same state where you are receiving services.

How can a Medicare beneficiary qualify for marriage and couples therapy coverage?

If you want to use Medicare for marriage and couples therapy, your first step is finding a provider who accepts Medicare. 

After you begin therapy, your provider must decide that marriage or couples therapy is medically necessary to help manage a mental health condition you are experiencing, such as anxiety or depression.

Does Medicare coverage work differently depending which plan you have?

Marriage and family counseling is covered under Medicare Part B. Medicare Part C (Medicare Advantage) also covers marriage and family counseling, but how it's covered and how much you will need to pay out of pocket with this coverage varies between plans. Sometimes Medicare Advantage will end up covering more of your care than Medicare Part B.

How many couples therapy sessions will Medicare cover?

Medicare doesn’t specify how many couples therapy sessions are covered. However, to continue receiving couples counseling covered by Medicare, your provider will need to document that your sessions are a medical necessity. This may include sharing clinical diagnoses with the insurance company.

Out-of-pocket couples therapy costs

While Medicare does cover marriage and couples therapy in certain circumstances, there may still be some out-of-pocket costs that you are responsible for. If you’re using your Part B benefits to pay for couples therapy, you have to meet your deductible before your insurance will cover it. As of 2026, the deductible for Part B is $286 per year. After you meet your deductible, you’ll be responsible for a copay equal to 20% of the Medicare-approved amount for services. This amount will vary from one provider to another. 

Because Sailor Health is in-network with Medicare (and many Medicare Advantage) plans, we’re able to make our services more accessible and affordable for our clients. In fact, most Medicare patients receiving therapy through Sailor Health have little or no out of pocket costs after the copay.

Are there exceptions or alternate Medicare plans it’s important to know about?

There are a couple of important stipulations to keep in mind when it comes to family and marriage counseling coverage under Medicare.

• Provider must accept Medicare assignment: In order to provide care for you, your family and marriage counseling provider must “accept Medicare assignment.” This means that they must accept the full amount that Medicare is willing to pay for their service. Your provider is not allowed to charge additional fees beyond what Medicare will reimburse. 
• Medicare Advantage requires provider enrollment: MHTs, MHCs, and other mental health providers can accept payment through Medicare Advantage plans (Medicare Part C). In order to qualify, they will have to enroll in the individual Medicare Advantage plan you have.

Finding a marriage therapist who takes Medicare

There are several different ways you can find a marriage or couples therapist who takes Medicare. Here are some places to start:

• Ask your primary care provider for a referral.
• Talk to other couples you know who have seen a Medicare-approved therapist for couples counseling.
• Search the American Association for Marriage and Family Therapy (AAMFT) therapist locator for marriage therapists near you and ask them if they accept Medicare.
• Use the Medicare.gov directory.
• Find a provider in your state who takes Medicare and begin therapy in as little as 24 hours with Sailor Health.

Our director of care offers a complimentary consultation to help match you with a therapist based on your needs and preferences - here’s where you can get started.

How Sailor Health can help

Sailor Health is a therapy provider specifically for seniors. We accept Medicare for payment and many of our therapists are experienced in couples counseling. You can browse a list of our providers, and do a search by specialty. Therapists who specialize in relationship issues, life transitions, and family dynamics may be good matches for you. You can also look at the profiles of our therapists and find ones that have experience with both individuals and couples.

At Sailor Health, all of our therapy happens via telehealth, either video calls or audio-only calls. This includes couples counseling. Telehealth therapy allows you to receive care in your home and at your convenience. It also means that you don’t have to wait many weeks or months to start your therapy journey.

Medicare and marriage counseling FAQ

If you have other questions about using Medicare for couples therapy, we’re here to help! Reach out to our team today. 

Is there an age limit for couples counseling?

Absolutely not. Therapy, including marriage or couples counseling, is available for adults of all ages. But older adults may feel more comfortable with an older, more experienced therapist, which is why Sailor Health’s mission is to provide exceptional mental health care focused on seniors. 

What type of marriage therapy can I access with Medicare?

There are various types of therapy that marriage counselors adopt, including cognitive‐behavioral couple therapy (CBT), integrative behavioral couple therapy (IBCT), and emotionally focused couple therapy (EFT). Medicare doesn’t place restrictions on the type of therapy a therapist practices as long as they are licensed under a Medicare-approved title, such as a clinical therapist, social worker, counselor, or MFT.

Is there a copayment for Medicare marriage counseling?

No, there is usually no specific copayment for Medicare marriage counseling. The amount you owe will be 20% of the Medicare allowed amount for your therapist’s services, after you have satisfied your deductible. If you receive care in a hospital outpatient clinic or hospital outpatient department, you may owe additional fees, including copayments. 

References

1. American Association for Marriage and Family Therapy. (2024). Support the generations that came before you. https://www.aamft.org/common/Uploaded%20files/Advocacy/AAMFT%20Medicare%20One%20Pager%20Final.pdf 
2. Medicare. (n.d.) Costs. https://www.medicare.gov/basics/costs/medicare-costs 
3. Lebow, J., & Snyder, D. K. (2022). Couple therapy in the 2020s: Current status and emerging developments. Family Process, 61(4), 1359–1385. https://doi.org/10.1111/famp.12824 
4. Centers for Medicare & Medicaid Services. (2025, April). Medicare & mental health coverage (MLN Booklet No. MLN1986542). https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf (cms.gov)
5. Centers for Medicare & Medicaid Services. (2024, May). Marriage and family therapists and mental health counselors: Provider enrollment FAQs. https://www.cms.gov/files/document/marriage-and-family-therapists-and-mental-health-counselors-faq.pdf
6. ‍Medicare. (n.d.) Mental health care (outpatient). https://www.medicare.gov/coverage/mental-health-care-outpatient