What's the difference? My insurance plan comes with a prepaid debit card I can use towards certain health benefits like a massage therapist. Would be nice to get a "free" massage! 
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As I understand it, a massage therapist has more training and can do things like massages for athletes, to address physical problems, etc. A spa masseuse is less trained and just does "relaxation massages". A massage therapist will also do that, though. I think a therapist is probably more expensive. I have massage therapy covered under my insurance too but it has to be from an RMT.
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I prefer going to a sports clinic so I don't have to tip (sorry, I hate tipping RMTs). Massage therapists at spas should usually be RMTs so it's covered under insurance either way. I do find that spa massages are more expensive.
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RMTs here are covered through insurance, and have to write exams to get registered through their 'college' (is that the right term?) Spa massages tend to be more expensive. I usually think of an RMT for things like prenatal massage, sports massage, or massage for injuries, whereas spa massages are JUST for the relaxation factor. I might be wrong though.
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Do you need to get a prescription to use the massage benefit?
As far as I understand it, LMPs are licensed by the state and can work in a spa setting or clinical setting. I prefer the clinical setting as I find that the therapists are more likely to take into account my requests for focus on pain relief of back, neck, shoulders, etc. I've also gotten some really great advice from LMPs about exercises/habits to help with pain relief.
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Massage therapist here!
There are two different types of massage practitioners- Licensed Massage Therapist (LMT) and Registered Massage Practitioner (RMP).
An LMT (what I am) has had more hours of classes, hands on training, and has to have their AA degree. They can work in any type of setting including hospital and doctor offices.
A RMP has had less class and training time. They normally complete a year or less program. They are not allowed to work in a medical setting.That being said, I work in a spa and perform many types of massage. Hot stone, pregnancy, deep tissue, swedish, sports, aromatherapy. So just because you go to a spa doesn't mean you'll be receiving a lesser massage.
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I have had a lot of both -- they are equally beneficial, in my experience, but in different ways. I saw a massage therapist in an office-type setting weekly for a few years. I found it very helpful to treat chronic problems. While overall the benefits were wonderful, sometimes the massages themselves weren't very relaxing because they were quite deep and/or theraputic. The setting of a spa massage has a big effect. I find them quite relaxing, which is an important benefit. But the muscular effects don't last, and sometimes I get frustrated because I want a deeper/more theraputic massage -- which I can really only get from my regular massage therapist, who knows my body so well.
Also, I find that spa massages focus on the neck and back, which are problem areas for most people. Arms and legs don't get as much attention -- almost like an afterthought. That seems to be the case even if I make special requests for more focus in a certain area. If you want a more complete massage, I would see a therapist.
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