When people estimate Texas child support, they often forget there's a second, separate piece: medical and dental support. Under Family Code §§154.181–154.182, this is ordered in addition to the guideline percentage — so the total a paying parent owes each month is usually more than the calculator's figure alone. This guide walks through the priority ladder courts follow, the 9% cash-medical cap with a worked dollar example, the separate dental piece, and how uninsured costs get split.
The three pieces of a Texas support order
A typical Texas order actually contains three money obligations, and they add up:
| Piece | What it is | How it's sized |
|---|---|---|
| Child support | The guideline percentage of net resources | 20–40% by number of children (§154.125) |
| Medical support | Health insurance for the child, or cash instead | Actual premium, or cash capped at 9% of annual resources |
| Dental support | Dental insurance for the child, or cash instead | Actual premium, or cash capped at 1.5% of annual resources |
The child support chart covers the first row. This page covers the other two — the rows that surprise parents at the final hearing.
The priority ladder: how a judge decides who covers the child
Texas doesn't leave the health-coverage question open-ended. Section 154.182 sets a priority order the court works down until the child is covered:
- First: insurance through the paying parent's employment. If the obligor has employment-based health coverage available at a reasonable cost, the court's default is to order the obligor to carry the child on that plan.
- Second: coverage through the receiving parent. If the obligee's plan is the workable option, the receiving parent carries the child and the paying parent is ordered to reimburse the premium as additional child support.
- Third: cash medical support. If health insurance isn't available to either parent at a reasonable cost, the court orders a monthly cash amount instead — capped at 9% of the obligor's annual resources — so the child's medical needs are still funded.
In weighing the options, the court looks at the cost, accessibility, and quality of the available coverage — but employment-based insurance sits at the top of the ladder whenever it's reasonably available.
If the paying parent provides coverage
This is the most common outcome. The obligor adds the child to an employer plan, and the child's share of the premium becomes part of the monthly cost of the order. There's a small silver lining: the premium for the child's coverage is one of the deductions used to compute net resources under §154.062(d). Carrying the insurance therefore slightly lowers the base the guideline percentage is applied to — the net-resources guide shows exactly where that deduction lands in the math.
If the receiving parent provides coverage
If the parent receiving support carries the insurance — say, through a better or cheaper employer plan — the court can order the paying parent to reimburse them the actual, reasonable cost of the child's portion of the premium. That reimbursement is treated as additional child support under the order, which means it flows through the same channels and carries the same weight as the guideline amount itself. Skipping it isn't a private matter between parents; unpaid amounts under the order accumulate like any other unpaid support.
Cash medical support: the 9% cap, with real numbers
When no reasonable insurance exists, the fallback is cash medical support — a monthly amount that may not exceed 9% of the obligor's annual resources. Here's what that ceiling looks like for a parent earning $5,000/month gross as a single W-2 employee:
- Monthly net resources under the 2026 tax method ≈ $4,199
- Annual resources: $4,199 × 12 = $50,388
- 9% cap: $50,388 × 0.09 = $4,534.92 ≈ $4,535/year
- Spread monthly: $4,535 ÷ 12 ≈ $378/month
Two things to keep straight. First, 9% is a ceiling, not an automatic amount — the court sets a figure up to that cap, informed by what coverage would have cost. Second, the cap runs on annual resources, which is why the arithmetic above annualizes the monthly net figure before applying the percentage.
Dental support: same idea, 1.5% cap
Texas treats dental coverage as its own obligation under §154.1815, ordered in addition to both child support and medical support. The structure mirrors medical support: dental insurance if it's reasonably available, or a cash amount otherwise — this time capped at 1.5% of the obligor's annual resources. On the same $50,388 of annual resources, that's $50,388 × 0.015 = $755.82 ≈ $756/year, roughly $63/month at most. Small next to the other pieces, but it's a real line in the order.
Uninsured and out-of-pocket costs
Insurance premiums don't cover everything. Co-pays, deductibles, prescriptions, glasses, braces — Texas orders commonly split these uninsured or out-of-pocket costs between the parents, frequently 50/50, on top of everything above. The split is set by the order's terms, so read yours: some orders allocate a different percentage, and most set rules for how one parent must document an expense and how quickly the other must reimburse their share. Keeping receipts and requesting reimbursement in writing avoids the classic dispute where a big orthodontia bill surfaces a year later with no paper trail.
What the full monthly stack can look like
Putting it together for the $5,000-gross parent with two children before the court:
- Guideline child support: $4,199 × 25% ≈ $1,050/month
- Medical support: the child's premium on an employer plan — or cash medical up to ≈ $378/month if no coverage is available
- Dental support: the dental premium — or cash up to ≈ $63/month
- Plus the parent's share of uninsured costs as they arise
That's why the realistic budget number is meaningfully higher than the guideline figure alone — and why the smart move is to run the base amount first, then layer the medical and dental pieces on top.
Common mistakes to avoid
- Budgeting only the guideline number. Medical and dental support are stacked on top, not included — plan for the full stack.
- Forgetting the premium deduction. If you carry the child's insurance, make sure that premium shows up as a §154.062(d) deduction when net resources are computed.
- Confusing the 9% cap with the amount owed. It's a maximum for cash medical support, not a default charge in every case.
- Paying uninsured costs informally with no records. Follow the order's documentation and reimbursement terms so your payments count.
- Ignoring the order after an insurance change. If coverage is lost or a job changes, the medical-support terms may need updating — see the modification guide rather than improvising.
Frequently asked questions
Is medical support included in the Texas child support percentage?
No. Medical and dental support are ordered in addition to the 20% / 25% / 30% guideline amount, not carved out of it. The paying parent's real monthly total is guideline support plus the child's health coverage (or cash medical support) plus dental support.
How much is cash medical support in Texas?
When health insurance isn't available at a reasonable cost, the court can order cash medical support capped at 9% of the paying parent's annual resources. For a parent with $4,199 in monthly net resources (about $5,000 gross), annual resources are $50,388, so the cap is about $4,535/year — roughly $378/month at most.
Does paying the child's health insurance premium lower my child support?
Slightly, yes. The cost of the child's health and dental insurance premiums is deducted when computing net resources (§154.062(d)), so carrying the coverage reduces the base the guideline percentage applies to. The net-resources guide shows the full deduction list.
Who pays for braces, co-pays, and deductibles?
Whatever the order says. Texas orders commonly split uninsured and out-of-pocket costs between the parents — frequently 50/50 — on top of the other obligations. Check your order's exact percentage and its documentation rules before assuming a split.
Is dental support separate from medical support?
Yes. Under §154.1815 dental support is its own obligation, ordered alongside medical support: dental insurance if reasonably available, or cash capped at 1.5% of annual resources (about $63/month on $50,388 of annual resources).