In this day and age of families that come in all shapes and sizes, a question that I have received multiple times from clients relates to how a stepchild can remain on their medical insurance after divorce. This is an important topic as it relates to both stepchildren and biological children alike. Amid a divorce case, this issue can get set on the backburner and not thought about all that often. However, if something happens to your child who requires medical care, you will want to make sure that health insurance coverage is in place. If not, a bad situation could become a horrible situation.
Let’s assume that you and your spouse are getting a divorce. The reality of that situation is that you will be living in one home after the divorce, and your spouse will be living in another. Any children that you had out of your marriage will be splitting time between those two homes. Your spouse’s children from a prior marriage or relationship will not have visitation with you since you are not a biological/legal parent. Nonetheless, if your stepchildren depended upon you for health insurance coverage, then they may be put into a dangerous situation by not having health insurance coverage.
Negotiations regarding health insurance coverage for biological children
When it comes to health insurance coverage for your children, you will want to make sure that you focus on this subject during the negotiation phase of your case. Keep in mind that most divorces in Texas never see the inside of a courtroom, and as a result, you cannot rely on a judge to keep this issue in mind. You and your spouse will need to devote some time to this subject. If you have specific concerns related to medical care and health insurance, you should make those concerns known to your attorney at the outset of your case.
You and your spouse have options in front of you to ensure that there are no gaps in coverage during this transition phase between marriage and divorce. It would help determine which one will be responsible for providing health insurance for the kids after the divorce. Depending upon which one of you (if either) has health insurance as a workplace benefit coverage for kids could be something that continues through the same parent after the divorce.
If neither of you has group health insurance coverage through your employer, you both will need to figure out the best, most cost-effective way to ensure your children. One of you may have to go into the health insurance marketplace and research the cost of purchasing health insurance on the open market. The fee may be split between the two of you in some way. Or, one parent may be tasked with paying the monthly premiums while co-pays and uninsured medical costs are divided between the two of you. Do not leave this issue as one that is not focused on. There is no better time to sort out health insurance details for kids than during settlement negotiations.
If you and your spouse have health insurance provided through your employers, you all will have less to negotiate about. This is an ideal situation because there is no way that your children will go uncovered. The cost of maintaining coverage will be relatively low due to your employer picking up costs (most likely) associated with the health insurance coverage. At that point, it is a decision between the two of you as to which plan will cost less money.
Which parent will pay the co-pays associated with your kids receiving medical care?
Not only is the issue of which parent will ultimately provide health insurance coverage very important to negotiate, but figuring out how co-pays will be handled should not be overlooked. Most divorces in Texas see parents split these sort of out-of-pocket costs 50/50. However, given that you and your spouse will have an opportunity to negotiate these issues yourselves, you can decide upon whatever percentage you would like. If you earn a great deal more than your spouse, you may choose to shoulder more of the burden of out-of-pocket costs.
The problem that you need to be aware of is that your spouse may end up violating these court orders down the line after your divorce has concluded. The doctor’s office will not keep a copy of your final decree of divorce at their office for reference when billing you and your ex-spouse. They expect payment in full by the due date. Likewise, you cannot go to the local police station and ask them for assistance in getting your ex-spouse to pay their fair share of the co-pay or uninsured costs of medical care.
Especially if you are the primary custodian of your kids and end up taking them to the doctor more than your spouse, each doctor your kids, treat with will expect you to be the one to pay the co-pay and other out of pocket expenses. According to your final decree of divorce, don’t expect the office to bill you for a certain percentage of those costs. It is not their responsibility to cater to you and your ex-spouse in this way.
You can attempt to work out a contract with the doctors that your children treat most frequently. Talk to the billing manager and see if they will accept a document stating what percentage you will pay and what your ex-spouse will pay. Larger hospital groups or clinical practices may not allow you to do this, but smaller offices may be willing to work with you all like this. However, you need to negotiate this with your spouse during the divorce and obtain their signature on a contract at that point. Do not wait to speak to your spouse after the divorce after. At that time, they are under no obligation to cooperate unless the divorce decree instructs them to do so.
What exactly does stepparent mean?
Now that we have discussed the broader topic of health insurance coverage for children in a divorce, we can move towards the case in the title of this blog post. When we talk about being a stepparent, that term has taken on meanings that could mean different things to different people. Not all insurance policies will allow for you to cover your stepchildren under your insurance policy.
As I alluded to at the outset of today’s blog post, modern families are often more complex than the traditional families we saw in years past. This is not a judgment on my part- it is more so an observation. While families have changed over the past few generations, health insurance plans and their coverage have not moved as quickly. The family used to mean one thing, and now our culture has stretched its definition to mean more stuff to more people.
Stepchildren are not always able to be covered under your health insurance plan. Biological and adoptive children are always covered as they are your legal children. Your stepchildren may live in your house, be provided for by you, and you may love them completely, but they are not your legal children. You have no legal relationship with them other than being married to one of their biological parents. Family coverage through an insurance policy does not cover certain members of your household if they are stepchildren.
How is adopting a child different than having a stepchild?
It depends on the type of health coverage that you have and the laws of the state of Texas as to whether or not your stepchild can be covered under your health insurance plan. There is typically no legal backing to your relationship with your stepchild despite all of the bonds that exist between the two of you. The stepchild’s biological parents are responsible for providing health insurance coverage for that child, just as you provide health insurance for your biological children. It does not matter if you identify your stepchild as your child, either.
In certain circumstances, you may be in a position where you could adopt your stepchild. To do so, the parental rights between your stepchild and their natural-born parent (not your spouse) would need to be terminated. Your stepchild would need to consent to the adoption, and you would then need to go about the formal, legal route of adopting that child. At this point, there would be no legal distinction between your natural-born children and your adoptive child. You could then provide health insurance coverage for your former stepchild.
However, I would still look into whether or not you can provide health insurance coverage for your child without having to go through the legal steps to adopt them. Of course, if you want to adopt your stepchild and believe that you are in a position to do so, that is up to you. However, as I mentioned earlier in today’s blog post, you may be able to cover your stepchild under your health insurance plan without having first to adopt them. Contact your provider or your work’s human resources department for further guidance on this. Do so early in the divorce process to know where everything stands well before the negotiation phase of your case.
A hypothetical question relating to stepchildren and health insurance
Let’s suppose that you are in a position where you can provide health insurance coverage to your stepchild. You are married to the child’s mother, and the child’s biological father has a court-imposed obligation to give the child health insurance. The child’s father has your step-son on Medicaid, but the father wants to take your child to the doctor at places that do not accept Medicaid. Do you have to give him this information about your insurance? After all, you are not obligated under a court order to do so, nor are you obligated to provide his child with access to your insurance coverage. What are your obligations in a situation like this?
In a situation like this, I would look at all of the court orders your spouse is living under with her ex-husband. You probably are not legally obligated to do so. Keep in mind that for healthcare expenses that Medicaid does not cover, your insurance may end up paying those. If you cannot provide your insurance information to that doctor, your wife may pay those uncovered medical expenses out of her pocket.
It would help if you worked with your spouse in a situation like this to see what she wants to do. After the all-the child is not yours, and the court order does not impact you. Whether it is a situation like this or any other dealing with court orders, you should contact an experienced family law attorney before doing something that you think may not be smart for you and your family on a long-term basis.
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Bryan Fagan, a native of Atascocita, Texas, is a dedicated family law attorney inspired by John Grisham’s “The Pelican Brief.” He is the first lawyer in his family, which includes two adopted brothers. Bryan’s commitment to family is personal and professional; he cared for his grandmother with Alzheimer’s while completing his degree and attended the South Texas College of Law at night.
Married with three children, Bryan’s personal experiences enrich his understanding of family dynamics, which is central to his legal practice. He specializes in family law, offering innovative and efficient legal services. A certified member of the College of the State Bar of Texas, Bryan is part of an elite group of legal professionals committed to ongoing education and high-level expertise.
His legal practice covers divorce, custody disputes, property disputes, adoption, paternity, and mediation. Bryan is also experienced in drafting marital property agreements. He leads a team dedicated to complex family law cases and protecting families from false CPS allegations.
Based in Houston, Bryan is active in the Houston Family Law Sector of the Houston Bar Association and various family law groups in Texas. His deep understanding of family values and his professional dedication make him a compassionate advocate for families navigating Texas family law.