The short answer is usually no. Most health insurance plans do not cover couples therapy. This frustrates a lot of people, and understandably so. You pay for insurance to help with healthcare costs, and your relationship directly affects your mental and physical health. But insurance companies don’t see it that way.

Here’s why, and what you can do about it.

Health insurance covers things that are considered “medically necessary.” That means treatment for a diagnosed medical or mental health condition.

“Relationship problems” is not a diagnosis. When two people come to therapy to work on their communication or reconnect after growing apart, there’s no medical code for that. Insurance companies view couples therapy as something you want, not something you need in a medical sense.

This is frustrating because we know that relationship stress affects health in real ways. It can contribute to anxiety, depression, sleep problems, and even physical issues like high blood pressure. But the insurance system wasn’t designed with that connection in mind.

There are some situations where insurance can offset part of the cost of couples therapy. These usually involve a workaround rather than direct coverage.

If one partner has a diagnosed mental health condition like depression, anxiety, or PTSD, insurance will often cover their individual therapy. Some therapists can bring the other partner into those sessions as a “collateral” or support person. The session gets billed under the diagnosed partner’s individual treatment, not as couples therapy.

This isn’t the same as true couples work where both people are equal participants. The focus stays on the diagnosed partner’s treatment. But it can still be helpful, especially if that partner’s mental health is affecting the relationship.

Another option is if the therapist determines that one partner qualifies for a diagnosis like adjustment disorder, which can apply when someone is having significant difficulty coping with a life stressor. In that case, the sessions might be billable to insurance.

Insurance plans vary a lot. Before assuming you have no coverage, call your insurance company and ask specific questions.

Ask whether your plan covers family therapy or family psychotherapy. Some plans that won’t cover “couples counseling” will cover sessions billed under family therapy codes.

Ask about the billing codes 90846 and 90847. These are the codes for family psychotherapy with and without the patient present. Your insurance representative can tell you if these are covered under your plan.

Be careful when an insurance company says they “cover couples counseling.” Sometimes this just means they’ll allow a spouse to be present in an individual therapy session, not that they’ll pay for actual couples work.

Check whether your employer offers an Employee Assistance Program. Many EAPs include free counseling sessions, and some of them cover couples therapy.

EAP benefits are usually limited to a small number of sessions, often three to six. That’s not enough to work through major relationship issues, but it can be a starting point. It’s also completely confidential from your employer.

Contact your HR department or benefits manager to find out what your EAP covers.

If you have an HSA or FSA through your employer, you can often use those funds for couples therapy. The money in these accounts is pre-tax, so you get some savings even though you’re paying out of pocket.

Check with your account administrator to confirm that couples therapy qualifies as an eligible expense under your specific plan.

Without insurance, couples therapy typically costs between $150 and $300 per session depending on the therapist and your location. Sessions are usually weekly, at least at first.

Some therapists offer sliding scale fees based on income. If cost is a barrier, ask about this when you call. Many therapists keep a few sliding scale spots available and would rather work with you on price than have you skip therapy altogether.

University training clinics are another lower cost option. Graduate students provide therapy under close supervision from experienced clinicians. The fees are much lower, often $25 to $75 per session.

Does my plan cover family therapy or family psychotherapy?

Are billing codes 90846 and 90847 covered?

What is my copay or coinsurance for outpatient mental health services?

Do I need a referral or prior authorization?

Is there a limit on the number of sessions covered per year?

Write down the answers and the name of the representative you spoke with. Insurance information can be confusing, and having notes helps if there are questions later.

The lack of insurance coverage for couples therapy is a real barrier for many people. It’s not fair, and it doesn’t reflect what we know about how relationships affect health.

But don’t let the insurance question stop you from getting help if your relationship needs it. There are ways to make it more affordable, and the investment in your relationship often pays off in ways that go far beyond dollars.

Whether you’re feeling stuck or just want to reconnect, we offer in-person couples therapy in Philadelphia and Haddonfield, as well as online throughout Pennsylvania and New Jersey.

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