Can I Use An HSA For Marriage Counseling?

Medically reviewed by Nikki Ciletti, M.Ed, LPC
Updated November 21, 2024by BetterHelp Editorial Team

Whether you’re newly married or have been with your spouse for decades, you may have discovered that marriage can come with challenges. Marital challenges like conflicts, significant life changes, communication difficulties, and other emotional and mental health challenges can negatively impact any relationship. For this reason, some couples turn to marriage counseling to address a specific issue or strengthen their relationship for the future.  

Because marriage counseling can be expensive, a common question among couples is whether they can use health savings accounts (HSAs) to offset the cost of their mental healthcare or marriage counseling. It can be helpful to look into the specifics of HSA processes to get started. 

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What Is A Health Savings Account?

When you have a high-deductible health insurance plan, you may pay lower monthly premiums but have a higher deductible on services. The deductible is the amount you must pay out of pocket before your insurance covers your healthcare expenses. In the United States, those with high-deductible health plans may have the option of opening a health savings account (HSA), which can help them manage their healthcare costs. 

If you qualify, you can contribute to an HSA like you might contribute to a savings account or retirement account. The difference is that the money you save in an HSA is earmarked to pay for eligible medical expenses. These expenses may include medical bills, psychiatric care, and other health services. For some, an advantage of an HSA is that contributions are made using pre-tax funds. Any money you put into an HSA is tax-deductible, and you don’t have to pay taxes on any interest that your contributions earn either. 

A health savings account is like a flexible spending account, but HSAs may have higher limits on the amounts you can contribute each year. Unlike flexible spending accounts, unused funds from an HSA can also carry over from year to year. Additionally, flexible spending accounts are tied to an employer, while HSAs are not. 

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Can You Use A Healthcare Savings Account To Pay For Marriage Counseling?

Marriage counseling can provide various benefits to couples, whether they are experiencing relationship challenges or wanting to plan for future challenges. Couples can improve their communication, address complications, and develop the skills to navigate future conflicts by working with a therapist. For these reasons, couples with health savings accounts often wonder whether marriage counseling is HSA-eligible. 

With many plans, individuals can only use an HSA for specific qualified purposes. If you use the money in an HSA for a non-qualified expense, you may be subject to a 20% withdrawal penalty. This penalty may be easy to avoid for most straightforward medical expenses, but the issue of HSA eligibility can become more complicated when it comes to mental health treatments. These services must be considered a medical necessity to use HSA funds for mental healthcare.

If you are using your HSA to pay for treatment for diagnosed mental health conditions—for example, medication or therapy sessions for bipolar disorder or depression—those expenses may qualify. However, counseling, including marriage counseling, is not often considered a “medical treatment” for a qualifying mental health condition. Therefore, it may not be covered by an HSA.

If you have specific questions about what your insurance plan or HSA does or does not cover, contact your healthcare plan provider to inquire. Marriage counseling may be covered under an HSA if one or both partners attend therapy to discuss a mental illness or medical concern with the therapist. 

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Online Therapy As An Alternative To Traditional Marriage Counseling

According to research, therapy has been proven to promote empathy in married couples, which could lead to increased relationship satisfaction and continuity. However, seeking marriage counseling can be frustrating for those who prefer to use health savings accounts to pay for their sessions. In-person counseling can cost from $175 to $275 per session on average for couples. This price can make therapy prohibitively expensive for many couples. 

Still, marriage counseling can have various benefits for couples of all ages and in all stages of their relationships. Although HSAs often don’t cover marriage counseling, therapy through an online platform like BetterHelp for individuals or ReGain for couples may provide an effective and affordable alternative.

Online providers can make couples counseling more convenient, eliminating the need to navigate the details of insurance or health savings accounts. The cost of therapy through an online platform can range from $65 to $90 per week, which translates to $30 to $45 per week for each spouse. 

The effectiveness of online relationship counseling has also been well-established. According to a 2022 study published in Frontiers in Psychology, couples who received therapy via videoconferencing experienced similar results to those who received traditional, in-person therapy. A 2020 study revealed that couples experienced a greater sense of connection to their therapists when they received therapy via videoconferencing. 

Takeaway

Health savings accounts (HSAs) are a type of savings account providing tax advantages to those who use them to pay for medical expenses. Although HSAs cover certain mental health-related expenses, marriage counseling does not often quality. Even without an HSA, online marriage counseling may offer cost benefits. Consider contacting alternative or sliding-scale therapists for further guidance in paying for services.
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