What Does Pet Insurance Cover?

·10 min read

Pet insurance coverage ranges widely by provider and it often covers less than what pet owners would expect. Interest in pet insurance has grown over the past year, but not all pet insurance policies are created equal. Some companies may offer comprehensive policies at competitive prices, while others might only have basic plans, with any extra coverage available as an add-on.

This guide breaks down what is and isn’t covered by most pet insurance policies. If you want to know which companies offer the best pet insurance coverage options, check out Money’s top pet insurance picks for 2021.

  • What is Covered by Pet Insurance?

  • Types of Pet Insurance Coverage

  • How Does Pet Insurance Work

What is Covered by Pet Insurance?

In general, most pet insurance plans will cover unexpected injuries/accidents, unexpected illnesses, surgery, medication, tests/diagnostics, and emergency care and exam fees. However, the details will depend on the type of coverage and the provider you choose.

Pet Insurance Type

What it covers

What it doesn’t cover

Accident-Only

-Physical accidents, including poisoning, foreign-body ingestion, cuts and lacerations, fractures, bloat, and surgery.

-Preexisting conditions
-Illnesses
-Intentional injuries
-Routine veterinary care
-May exclude older pets
– May not cover poisoning in certain circumstances

Accident & Illness

-Mild to severe illnesses, including allergies, cancer, asthma, and digestive issues.
-Hospitalization, treatment, surgery costs, and prescription medication.
-Can cover alternative therapies

-Preexisting conditions
-Routine veterinary care, including vaccinations, dental cleaning, among others.
-May exclude pets over a certain age limit.
-Can exclude certain prescription medications.

Wellness

-Exam fees, vaccinations, routine lab work, spay/neuter operations, among others.

-Any pet-related illnesses or accidents

Types of Pet Insurance Coverage

Insurers mix and match their policies into three main coverage areas: accident-only coverage, accident and illness coverage, and wellness coverage. Specific benefits and restrictions within each area differ by company, which is why we cover pet insurance costs separately.

For instance, although all the companies we’ve researched cover hip dysplasia, some impose an age limit on treatment and will deny coverage to older dogs. Others have no restrictions for the same condition.

1. Accident-only coverage

Pros

Cons

More affordable monthly premiums

Less coverage

Only covers injuries from an accident

Illnesses and routine care are still out-of-pocket expenses

Best for young, healthy pets unlikely to develop a hereditary condition

Lowest reimbursement level for procedures

What is covered by accident-only insurance

Accident-only policies reimburse the cost of treating injuries or illnesses caused by mishaps, whether they’re the animal or its owner’s fault. You’re also covered for certain breed tendencies that can lead to accidents like eating non-food stuff that requires expensive surgery to remove.

While the cost to remedy such behaviors won’t subsequently boost your monthly premiums, the track records of certain breeds for self-harm, like their medical pre-dispositions, may affect how much you’ll pay to insure them.

What isn’t covered by accident-only insurance

Any accident that can be traced back to the pet owner, such as intentional injuries, or any that result from organized sports will not be covered. Likewise, any accident resulting from a pre-existing condition won’t be covered either.

Accidents: What Is and Isn’t Reimbursed

Covered

May not be covered

Motor-vehicle accidents

Poisoning

Ingesting foreign bodies

Intentional harm to the animal

Sprains and lacerations

Injuries in organized fights or races

Broken Bones

MRIs and x-rays for diagnostic

Based on information gathered online by Money staff from the websites of the pet insurance companies, supplemented by research of other types.

Not all policies cover poisoning and flea or tick bites, since that is often the result of owner negligence. Additionally, accident-only policies don’t cover routine care, such as vaccinations, spaying, or neutering. As with any type of coverage, consult company policies to check what is and isn’t covered.

2. Accident and illness coverage

Pros

Cons

Covers injuries from accidents

Monthly premiums are higher than for accident-only coverage

Covers vet-diagnosed sickness or disease

Often won’t cover routine care, like check-ups and teeth cleanings

Good fit for breeds that commonly experience health care problems

Reimbursements are capped per accident and per illness

May include optional wellness rider for an extra fee

What is covered by accident and illness insurance

Although some insurers have illness as its own category, it’s far more common to bundle it with accidents. Accident & Illness policies cover a gamut of illnesses, from the minor — such as vomiting and diarrhea, even if due to unidentified causes — to the serious, like cancer. They can also cover all veterinary examination and consultation fees, hospitalization, treatments, surgery costs, and prescription medications.

Unfortunately, some policies omit certain types of prescriptions — such as those for behavioral problems — and put the pet owner on the hook for exam fees. Most of these insurance policies also cover hereditary and congenital conditions that are breed-specific, like torn ligaments. However, this is only true so long as your vet identifies the problem after the policy is in place. If your dog suffered any of these conditions before enrollment, they will be considered “pre-existing” and won’t be covered.

Some policies cover specific conditions, but only after a waiting period elapses. For example, an insurance company might pay for surgery to alleviate hip dysplasia, but only if treatment happens at least six months after the policy takes effect.

Other serious illnesses that are usually covered

Virtually every pet accident & illness policy covers cancer and specialty care of any kind. Here are other specific conditions, both chronic and inherited, for dogs and cats that you can typically expect coverage for, although not every insurer may include every single one.

Dogs

Cats

Hepatitis

Polycystic Kidney Disease (PKD)

Arthritis

Feline Lower Urinary Tract Disease (FLUTD)

Skin allergies

Inflammatory Bowel Disease

Hip dysplasia

Hyperthyroidism

Elbow dysplasia

Diabetes mellitus

Hypothyroidism

Type II diabetes (linked to obesity)

Based on information gathered online by Money staff from the websites of the pet insurance companies, supplemented by research of other types.

Comprehensive coverage – what is and what isn’t included

Comprehensive plans are a variant of regular accident and illness coverage that tack on wellness coverage, sometimes as a separate plan or as an add-on. This can include alternative therapies, and a whole host of additional covered treatments, from behavioral therapy, acupuncture, and chiropractic care, to laser therapy and hydrotherapy. Some plans also cover specific dietary supplements and foods needed to treat your pet’s health condition.

The one caveat — despite the name, comprehensive coverage usually won’t include routine checkups, vaccinations, or flea and heartworm treatment.

3. Wellness coverage

Pros

Cons

Reimburses for preventative (routine) care

Usually isn’t a standalone policy, but an add-on or rider

Usually zero deductible

What is covered by wellness insurance

Often referred to as “preventive care” coverage, wellness coverage is available as an add-on or “rider” to a broader policy or, with some carriers, as a separate stand-alone policy.

Many routine veterinary care procedures are typically included. Other services like grooming and training services can sometimes also be included.

Wellness: What Is and Isn’t Reimbursed

Covered

May not be covered

Vaccination

Pregnancy or other breeding/ whelping expenses

Flea/tick and heartworm preventatives

Routine anal-gland expression

Microchipping

Grooming or training

Spay/neutering surgery

Based on information gathered online by Money staff from the websites of the pet insurance companies, supplemented by research of other types.

How Does Pet Insurance Work?

Pet health insurance works a bit differently than traditional insurance. Whenever you visit your licensed veterinarian, if the medical expenses are covered by your pet’s insurance plan, the pet insurance provider will reimburse you for a percentage agreed via your insurance plan.

As with human health insurance, there is a deductible, typically between $200-$1,000, that you choose, and that you have to pay before the insurance kicks in.

Pre-existing conditions

As a rule, insurers don’t cover pre-existing conditions and every insurer has a different definition of what constitutes one. Your pet insurance company may offer you a policy even if your pet has a veterinary diagnosis, it just won’t cover you for anything related to a pre-existing or chronic condition.

Waiting periods

The reason for waiting periods is simple: they prevent pet owners from rushing to insure their animals after any diagnosis or symptom pops up. The traditional waiting period for pet insurance policies is 14 days, except for hip dysplasia and other conditions that have their own specific periods.

Policy Limits

Most policies require that you choose certain coverage limits. These include an annual limit on reimbursed expenses, typically within a range of $5,000 to $30,000 — the higher the limit, the higher the premium.

It’s rare that a policy pays the entire expense for any care since covered costs are usually a set percentage — typically between 70%, 80%, or 90%. As with many other insurances, you must also select an annual deductible to be paid upfront before reimbursement kicks in. These normally range around $250, $500, or $1,000.

Finally, many insurers have age limits to coverage, meaning after a certain age, coverage will stop on an existing policy. Likewise, some pet insurance companies won’t take out new policies on pets over a certain age limit.

Pet Insurance Coverage FAQ

Is pet insurance worth it?

Whether pet insurance is worth it or not ultimately depends on your budget as a pet parent and your pet’s health needs. If your pet is young and healthy, pet insurance may not be as necessary — though the older they get, the more expensive to insure. If your pet is older and its breed has a history of illnesses, pet insurance could be a help in the long run. Before committing to a pet insurance policy, always consider its overall costs, and compare it to the potential veterinary bills you might incur. If the difference is considerable, chances are that your pet can benefit from pet insurance.

How much is pet insurance?

The cost of pet insurance will depend on the pet type, age, breed, and gender, in addition to the type of policy, co-pay, deductible, and reimbursement level you prefer. Premiums will also vary depending on where you live. Policy rates for cities with higher costs of living, like New York or California, are prone to cost more. Most companies offer online insurance quotes.

How much is pet insurance?

Pet insurance premiums vary greatly but aren’t necessarily expensive. The North American Pet Health Association (NAPHIA) estimates that dog insurance costs an average of $585 per year for accident & illness and $194 for accident-only plans. Cat insurance averages $349.93 for accident & illness and $126.08 for accident-only.

Does pet insurance cover hip dysplasia?

Accident-only plans cover vet bills like toxin ingestion and physical injuries, while illness plans cover illnesses like ear infections, cancer, and hereditary conditions such as hip dysplasia. Embrace, a pet insurance agency, is a great example of a unique policy since its Accident & Illness plan includes protection for pre-existing conditions they consider “curable”. The company determined specific curable pre-existing conditions if they don’t recur for at least one year.

What is the best affordable pet insurance?

Accident-only and wellness plan policies are the most affordable pet insurance plans, mainly because they are less comprehensive. However, purchasing one of these policies will only cover specific aspects of your pet’s health, like fractures and cuts for accident-only, and routine labs for wellness-only plans. If you want a more comprehensive policy, you will have to pay more.

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