Who Pays for Children's Medical Expenses?

Medical expenses are one of the more consistently addressed cost categories in custody orders, because family courts generally expect parents to share responsibility for a child's medical and dental care in some form. The specifics, who provides insurance, and how uninsured costs get split, vary significantly by state and by the individual order.

Health insurance coverage

Whoever maintains the child's health insurance is typically addressed directly in the custody or divorce order, courts commonly order whichever parent has access to affordable coverage, often through an employer, to maintain it, with details varying by state and situation. If you don't already know which parent is responsible under your specific order, that's worth confirming directly rather than assuming.

Uninsured or out-of-pocket costs

Copays, deductibles, and costs insurance doesn't cover (orthodontia is a common example) are usually addressed separately from the insurance question itself. How these get split varies meaningfully by state:

• Some states split uninsured medical costs proportionally to each parent's income
• Some states make the parent without primary custody responsible for costs above a certain threshold or their support obligation
• Some states build a specific dollar amount (for example, a set annual figure) into the base child support calculation, with the custodial parent responsible up to that amount

Because this varies by state and by your specific order, the details here are general information, not a substitute for reading your own order or checking with an attorney about how it applies to you.

If your situation isn't already addressed

If there's no existing order or agreement covering medical costs, or the existing one is vague, it's worth resolving this before a specific bill becomes a dispute, through direct agreement, mediation, or, if needed, a formal modification. Waiting until an actual expense is in dispute tends to make the conversation harder than deciding the framework in advance.

What to agree on, at minimum

• Who maintains insurance coverage, and what happens if that changes (a job change, for example)
• How uninsured costs are split, evenly, by income, or some other method
• What the process is for requesting reimbursement, see how to ask a co-parent for reimbursement
• A reasonable timeline for submitting and paying medical reimbursement requests

Keep a record as costs come up

Medical costs tend to arrive with a receipt or an insurance statement already attached, worth logging them as they happen rather than trying to reconstruct a year of medical expenses later. See how to track and document shared child expenses, and use the calculator below once you know your split method.