Raising a child in New Braunfels means well-child visits, sports physicals, the occasional trip to urgent care after a tube on the Comal goes wrong, and, for many families, braces. Texas child support orders handle those costs separately from base support. Every order in Comal County that sets support also has to address health insurance, dental insurance and the bills insurance does not cover. Understanding these provisions now can prevent years of arguing over receipts.
Medical Support Is Separate From Base Support
The guideline percentages, 20% for one child and so on, cover the child’s everyday needs. Medical support and dental support are ordered on top of that amount. They address three separate questions:
- Which parent will carry health insurance and dental insurance for the child?
- How much will the other parent pay toward the premiums?
- How will the parents split costs that insurance does not cover?
A well-written order answers each question clearly. A vague one leads to disputes.
How Texas Courts Choose Health Insurance
Texas Family Code Chapter 154 sets an order of priorities. In general, the court looks first at whether health insurance is available to either parent at a reasonable cost, usually through an employer. Texas measures reasonable cost by comparing the premium for the child’s coverage to the paying parent’s resources. Courts often prefer the plan that gives the child the best access to care at a reasonable price.
The usual results look like this:
| Situation | Typical order |
|---|---|
| Paying parent has coverage at reasonable cost | Paying parent keeps the child insured through that plan |
| Receiving parent has coverage at reasonable cost | Receiving parent insures the child; paying parent reimburses the premium as additional support |
| Neither parent has reasonable private coverage | Court may order a parent to apply for Medicaid or CHIP, or to pay cash medical support |
| Child already has public coverage | Court may order cash medical support toward the cost of care |
When the paying parent reimburses premiums, the amount is usually the cost of covering the child, not the cost of the whole family plan. Ask the employer or insurer for a breakdown of the premium for the employee alone and for the employee plus child. That difference is often the figure the court uses.
Health insurance premiums for the child are also subtracted when calculating net resources, so they affect the base support amount too.
Dental Support
Texas courts also order dental support. If dental insurance is available at reasonable cost, the order will name the parent who carries it and set any reimbursement. Dental coverage is usually less expensive than medical coverage but often has lower annual maximums. As a result, braces, crowns and oral surgery frequently become uninsured expenses.
Uninsured Medical and Dental Expenses
No plan pays for everything. Deductibles, copays, prescriptions, eyeglasses, counseling and orthodontics often fall outside coverage. Texas orders typically assign a percentage of these reasonable and necessary uninsured costs to each parent. Many orders split them equally, but a court can divide them differently when the parents’ incomes are very unequal.
Most orders also set out procedures, such as:
- How soon the parent who incurs a bill must send it to the other parent
- What documents to include, such as an explanation of benefits or receipt
- How long the other parent has to pay their share
- Whether to use in-network providers when they are reasonably available
Missing a deadline in the order can weaken your claim for reimbursement, so read those paragraphs closely and keep good records.
Counseling, Therapy and Special Needs
Counseling, speech therapy and occupational therapy are common costs for children of separated parents. Whether they count as health care expenses depends on how your order defines them. If your child has ongoing medical or developmental needs, raise them when support is first set. Those needs can also justify support above the guidelines.
Practical Tips for Comal County Parents
From our experience working with parents in New Braunfels and the surrounding counties, a few habits prevent most medical-support disputes:
- Use one shared method. Email or a co-parenting app creates a dated record of each bill sent and each payment made.
- Send bills promptly. Do not let receipts pile up for a year and then send a large total.
- Keep the insurance cards current. The parent carrying coverage should give the other parent cards and plan information, especially after an open-enrollment change.
- Talk before elective care. Non-emergency orthodontics or elective procedures go more smoothly when both parents know in advance.
- Report coverage changes. Texas orders usually require a parent to notify the other parent if coverage ends or changes. Losing a job, and with it employer insurance, is a common reason to review the order.
Our co-parenting guide offers more ideas for handling shared costs without conflict.
Keeping a Simple Expense Log
A basic shared spreadsheet can prevent most arguments. For each expense, record the date of service, the provider, the total charge, what insurance paid, the amount left over, the date you sent it to the other parent, and the date and amount they reimbursed. If the matter ever goes to court, that log, backed by receipts, becomes the core of your evidence.
When Medical Support Needs to Change
Insurance changes often. Premiums go up, employers switch carriers, parents change jobs, and children age into new needs. A significant change in insurance cost or availability can support a child support modification. For example, imagine a mother who covered her son through her employer at a modest premium and then took a job with a small business in Seguin that offers no dependent coverage. A modification could shift the duty to insure to the father or set cash medical support.
If the other parent has stopped paying premiums or ignored medical bills, the unpaid amounts can generally be pursued through the same tools used for other unpaid support. Our page on enforcement and arrears explains those options.
Medical Support Help From a New Braunfels Family Lawyer
Insurance provisions are easy to overlook when parents are focused on the base support number, but they can add up to thousands of dollars over a child’s life. Our family law team helps parents in New Braunfels and Comal County draft clear medical and dental provisions, recover unpaid bills, and update orders when coverage changes. Call (830) 302-4071 for a free consultation. Se habla español.
Frequently Asked Questions
Is medical support part of the 20% guideline for one child?
No. Medical and dental support are ordered in addition to base child support. A parent paying guideline support for one child will usually also reimburse the other parent for part or all of the child’s insurance premiums, plus a share of uninsured costs.
Who pays for braces under a Texas child support order?
Orthodontic work is usually treated as an uninsured health care expense unless the order says otherwise. Many orders divide those costs between the parents. Read the definitions in your order carefully, because some orders treat orthodontics differently from routine dental care.
What if the other parent will not pay their share of a medical bill?
Send a copy of the bill and proof of what you paid within the time limit in your order, and keep proof that you sent it. If the other parent still does not pay, the unpaid amount can usually be enforced like other support, including a money judgment.
Can my child be covered by Medicaid or CHIP instead of private insurance?
Yes, in some cases. If private coverage is not available at a reasonable cost, the court may order the parents to apply for public coverage or order cash medical support. Eligibility depends on household income and program rules.
Does my new spouse's insurance plan count?
It can. If a stepparent’s employer plan covers the child, the order can account for that. The court focuses on whether the child has coverage and what it costs, not just whose name is on the card.
Last reviewed November 13, 2026. General information only, not legal advice.