Marriage Counseling: HSA Eligibility

What is marriage counseling?

Marriage counseling, also known as couples therapy, is a type of counseling that is hosted by licensed therapists known as marriage and family therapists. The aim of these counseling sessions is to resolve conflicts and improve the relationships between couples, and typically this counseling is of a short-term manner and can be conducted with both individuals in the room, as well as solo sessions with a therapist as well. Ultimately, marriage counseling is used to identify whether a relationship can be salvaged or if it's best for the two individuals to go their separate ways (Mayo Clinic).

Over the course of a marriage counseling regimen, therapists will aim to hit on a wide range of points that may reveal truths and behaviors that may not have occurred to the couple that could serve as a building block to improve their relationships. In particular, therapists will focus on communication issues, anger, infidelity, substance abuse, sexual issues, financial problems, child-rearing difficulties and more. Marriage counseling is available to those in heterosexual and homosexual relationships, as well as those who are married or unmarried.

Why isn't marriage counseling eligible for reimbursement?

Under IRC 213(d)(1), "medical care includes amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." This includes medical equipment, supplies and devices." Marriage counseling does not directly relate to the diagnosis, cure, mitigation, treatment or prevention of a legitimate medical condition, and therefore would not be eligible for reimbursement with consumer-directed healthcare accounts like FSAs, HSAs, HRAs, DCFSAs or LPFSAs.