He played college football for the Kentucky Wildcats, where he set the Southeastern Conference record for single-season passing yards and won the Quarterback of the Year as a junior.

Following attempted comebacks with the Green Bay Packers and Jacksonville Jaguars, he retired after failing to make the final roster for either team.

During his 1996 freshman year under head coach Bill Curry, he split time as the starting quarterback with Billy Jack Haskins.

Curry was fired after a 1–6 start that season, and replacement Hal Mumme announced early that Couch would be the starter in his new pass-oriented air raid offense.

Couch's tenure in Cleveland ranged from leading the team to a playoff appearance, to boos and inconsistent play, which was partially a result of being constantly plagued by injuries.

The high point of Couch's career came in 2002, when he threw for 2,842 yards and 18 touchdowns in leading the upstart Browns to a 9–7 record and a playoff appearance.

[13] However, he suffered a broken leg in the final game of the regular season and was forced to watch as Holcomb threw for over 400 yards in a loss to the Pittsburgh Steelers in the Wild Card round of the playoffs.

This was the beginning of a quarterback controversy in Cleveland that would not be resolved until a year later when head coach Butch Davis tapped Holcomb as his starter.

[14] Couch is considered by Fox Sports to be one of the NFL's biggest draft busts in its history after being taken #1, immediately ahead of fellow quarterback Donovan McNabb, only to falter through most of his career.

[16] Couch holds the distinction of being the only quarterback in NFL history to throw two walk-off touchdown passes of 50 yards or more with 0:00 left on the clock.

However, the team, led by Couch, won 9 games, including five in the final two minutes and seven by 10 points or less, and made a wildcard playoff spot.

Couch filed a grievance with the NFL Players Union against the Packers because they failed to attempt an injury settlement prior to his release.

After undergoing shoulder surgery in February 2005, Couch auditioned for the Chicago Bears midway through the 2005 season and the Cincinnati Bengals in December 2005.

[25] Currently Couch and an older brother Greg are part owners of Meridian Wealth Management, a nationwide company based in Lexington.