Health Insurance and Medical Expenses in Child Support
Lead Research Analyst • 8 years experience
Health insurance premiums and extraordinary medical expenses are key components of Indiana child support calculations. Understanding how these costs are handled can significantly impact your total obligation.
Health Insurance Premiums
What Qualifies
The cost of health insurance coverage specifically for the child, including:
- Health/medical insurance premiums
- Dental insurance premiums
- Vision insurance premiums
- Only the portion covering the child (not the parent's own coverage)
How Premiums Are Split
Health insurance premiums are divided proportionally by income, just like basic support:
Example
Parent A income: $70,000 (70% of combined)
Parent B income: $30,000 (30% of combined)
Health insurance for child: $80/week (Parent A pays)
Split:
Parent A's share: $80 × 70% = $56/week
Parent B's share: $80 × 30% = $24/week
Result: Parent B reimburses Parent A $24/week through child support payment.
Extraordinary Medical Expenses
What Counts as "Extraordinary"
Uninsured medical expenses exceeding $100 per child per year, including:
- Co-pays and deductibles
- Prescription medications
- Orthodontic treatment (braces)
- Physical therapy
- Mental health counseling
- Specialty care not covered by insurance
What's NOT Extraordinary
- Over-the-counter medications
- Routine dental cleanings (covered by basic obligation)
- Eye exams (if not needed for medical condition)
- Cosmetic procedures
How Extraordinary Expenses Are Paid
Parents typically split uninsured medical costs proportionally to income:
| Expense | Total Cost | Parent A (70%) | Parent B (30%) |
|---|---|---|---|
| Braces | $4,500 | $3,150 | $1,350 |
| ER visit co-pay | $250 | $175 | $75 |
| Annual prescriptions | $600 | $420 | $180 |
Court Orders Typically Require
- Maintain insurance: One parent must maintain health insurance if available at reasonable cost (typically <5% of gross income)
- Share costs: Premiums split proportionally
- Notify other parent: Before non-emergency medical care exceeding $100
- Provide documentation: Bills, EOBs (Explanation of Benefits), receipts
- Timely reimbursement: Usually within 30-60 days of receiving bill
Who Maintains Insurance?
Courts typically order the parent with better/cheaper coverage to maintain insurance. Factors considered:
- Cost of adding child to plan
- Quality of coverage (deductibles, network)
- Employer contribution
- Accessibility to providers
How to Calculate the Child-Only Premium
One of the most common mistakes is entering the full family premium instead of the child's portion. If a parent already pays for employee-only coverage, the relevant amount is usually the extra cost to cover the child. For example, if employee-only coverage is $60 per week and employee-plus-child coverage is $95 per week, the child-only premium is $35 per week.
If a plan covers multiple children, divide the child portion in a reasonable and documented way. Keep the benefits statement or employer premium chart so the number can be verified later.
Impact on Total Support
Example showing full impact of health costs:
| Component | Amount |
|---|---|
| Base child support (1 child) | $350/month |
| + Health insurance share (30%) | +$104/month |
| + Average extraordinary medical (30%) | +$15/month |
| Total monthly obligation | $469/month |
| Plus one-time expenses (braces, ER visits) as incurred | |
Common Disputes & Solutions
Parent won't share receipts
Solution: Most orders require provision of itemized bills within 30 days. File contempt motion if parent refuses.
Parent seeks unnecessary treatment
Solution: For non-emergency care over $100, orders typically require advance notice. You can object to unnecessary procedures.
Can't afford large medical bill
Solution: Negotiate payment plan with provider. Court orders usually allow reasonable time (30-60 days) for reimbursement.
Tax Implications
- Medical expense deduction: Only the parent who pays the medical expense can deduct it (if itemizing and exceeds 7.5% of AGI)
- Insurance premiums: If self-employed, the parent paying premiums may deduct them
- FSA/HSA: The parent with the dependent exemption can contribute to these accounts
When Child Turns 18
Indiana child support typically ends at age 18 or high school graduation (up to age 19), but health insurance obligations may continue if:
- Child attends college (if specified in divorce decree)
- Child has special needs requiring ongoing care
- Parents agree to extend coverage
Note: Under the Affordable Care Act, children can remain on parent's insurance until age 26 regardless of support obligations.
Documentation Checklist
Keep these records for reimbursement and tax purposes:
- ☐ Insurance cards (front and back copies)
- ☐ Premium statements showing cost for child's coverage
- ☐ Explanation of Benefits (EOB) for all claims
- ☐ Receipts for co-pays and deductibles
- ☐ Prescription receipts
- ☐ Cancelled checks or payment confirmations
- ☐ Email/text communications about medical decisions
Practical Review Before Using a Calculator
Before entering health costs into a child support calculator, confirm three points: the premium is the child-only cost, the expense is current, and the paying parent can document it. If the number comes from an old enrollment period or includes adult coverage, the estimate can be overstated.
For uninsured expenses, separate recurring costs from one-time costs. A monthly prescription may belong in a different planning category than a single emergency room bill. If parents disagree about reimbursement, the clearest records usually include the provider bill, the insurance Explanation of Benefits, proof of payment, and the date the other parent was asked to reimburse their share.