Pet insurance coverage varies widely by provider and plan, and some of the exclusions may surprise you. Insurers cover diagnostic tests, surgery, hospitalization and even physical therapy if it’s necessary to treat injury or illness. But even the best pet insurance companies exclude checkups, vaccinations, grooming and other recurrent pet care expenses.
This guide breaks down what is and isn’t covered by most pet insurance policies. If you want to know the companies that offer the best pet insurance coverage options, check out our picks for the best pet insurance companies.
Table of Contents
- What is Covered by Pet Insurance?
- What is not covered by pet insurance?
- Types of Pet Insurance Coverage
- How Does Pet Insurance Work?
- Is pet insurance worth it?
- Pet Insurance Coverage FAQs
- Summary of Money’s Guide to Pet Insurance Coverage
What is covered by pet insurance?
In general, most pet insurance plans cover treatment for unexpected injuries, accidents and illnesses. The costs for surgery, medication, X-rays, blood work and emergency care are typically included.
However, not every veterinary bill in those categories is automatically eligible for reimbursement. A claim may be denied if the pet insurer can establish a connection between the injury and the owner’s negligence. Certain illnesses may also be excluded if the animal hasn’t received proper preventative care.
These are the injuries and illnesses that most pet insurance providers will cover.
What is not covered by pet insurance?
Pet insurance won’t cover medical treatment for the following:
- Incidents in which the pet owner is at fault such as striking the pet or subjecting it to organized fighting or racing
- Injuries and illnesses that result from pre-existing conditions
- Repeat vet visits for issues that could be prevented by the owner after the first occurrence (compulsive ingestion of foreign objects, for example)
- Preventive care: teeth cleaning, anal gland expression, grooming, vaccines and nail trimming
- Complications due to breeding and whelping
Types of pet insurance plans
Insurers typically offer two coverage options: accident-only plans and accident and illness coverage. You can also add wellness coverage to your base policy as a supplemental benefit, but this package isn’t considered pet insurance. Your pet insurance costs will vary depending on the type of plan you choose, among other factors.
1. Accident and illness coverage
What is covered by accident and illness insurance
Accident & illness policies (also typically known as “comprehensive 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.
Virtually every pet accident & illness policy covers cancer and specialty care of any kind. Here are examples of additional chronic and inherited conditions that you can typically expect coverage for.
Your pet insurance policy will cover most, if not all of these services for covered conditions:
- X-rays, MRI scans, CT scans
- Veterinary examination and consultation fee
- Hospitalization
- Blood tests and ultrasounds
- Chemotherapy
- Surgery
- Medications (administered in-office or take-home prescriptions)
- Alternative care (Acupuncture, hydrotherapy and chiropractic care)
- Stem cell treatment
- Behavioral modification
- Laser therapy
Common coverage restrictions
As with most other treatments, hereditary and congenital conditions are covered only so long as a 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 will not be covered.
Some policies also cover specific conditions only after a waiting period elapses. For example, an insurance company might pay for surgery to alleviate hip dysplasia, but only if the illness was diagnosed at least six months after the policy took effect.
Insurers set additional restrictions depending on your pet’s age. Treatment for congenital or hereditary dental issues may be excluded if you enroll a pet that’s already one year old, and hip dysplasia is often excluded from coverage if the pet is six years or older at the time of enrollment.
2. Accident-only coverage
What is covered by accident-only insurance
Accident-only policies reimburse the cost of treating injuries or illnesses caused by mishaps, whether they’re self-inflicted by the animal or result from some other cause.
Claims for accidents stemming from such behaviors won’t increase your monthly premiums. But those fees may be determined in part by the propensity of your animal’s breed to accidents. For instance, premiums tend to be high for Labrador Retrievers in part because of the breed’s tendency to swallow foreign objects.
Accidents: What is and isn’t reimbursed
When you buy pet insurance, read the fine print to verify what is and isn’t covered. For instance, not all policies cover poisoning and flea or tick bites, since those perils are often the result of owner negligence.
3. Wellness coverage
Wellness: What is and isn’t reimbursed
Often referred to as “preventative 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 are also sometimes within scope.
Pet insurance optional extras
In addition to wellness riders, pet insurers may also sell the following add-ons:
- Behavioral modification
- End-of-life expenses
- Lost or stolen pet advertising and reward
- Value of lost or stolen pet if not found
- Pet boarding due to owner’s hospitalization
- Liability coverage
Not every company structures its benefits the same way so you’ll find providers that include these riders in wellness care packages while others sell each benefit separately.
The latter is most common with policies that you can customize to fit your budget. Lemonade pet insurance, for example, sells coverage for dental illness, behavioral modification and end-of-life expenses separately.
Compare pet insurance coverage
How Does Pet Insurance Work?
Reimbursement under pet health insurance differs from human health insurance. Much like homeowners or auto insurance, you’re responsible for paying the bill upfront (unless your insurance provider offers direct payment to vets). You then make a pet insurance claim and wait to be reimbursed according to the terms stipulated in your insurance plan.
These are the key terms policyholders should understand:
Pre-existing conditions
As a rule, insurers don’t cover pre-existing conditions. If your animal has a medical problem that predates you enrolling them for insurance, you can’t claim the cost of treating it. This exclusion also applies to any medical complications that can be linked to a pre-existing issue.
Some conditions — infections, allergic reactions and stomach bugs, for example — may eventually be covered, provided your pet is symptom-free and deemed to be cured for a certain length of time (often 180 days). Every insurer has a different definition of what constitutes a curable pre-existing condition, so it pays to dig into these details before you buy a policy.
Waiting periods
The reason for waiting periods is simple: they prevent pet owners from rushing to insure their animals after a diagnosis or the onset of symptoms. The standard waiting period for pet insurance policies is 14 days, and some providers set a shorter one- to three-day waiting period for accident-only coverage.
Hip dysplasia, cruciate ligament conditions and spinal injuries have their own specific periods. Insurers may make you wait anywhere from six months to a year before you can file a claim related to these orthopedic conditions.
Policy limits
Pet insurance providers require you to choose certain coverage limits.
Annual payout limits
Policyholders can choose how much the company will pay out in a given year, often within a range of $5,000 to unlimited — with higher limits generally triggering higher premiums.
Some providers also impose lifetime limits and limits on the treatment costs for specific conditions such as dental illnesses. Wagmo pet insurance, for example, sets a lifetime limit of $100,000, and Lemonade pet insurance caps dental illness coverage at $1,000 a year.
Reimbursement rate
Annual limits are a maximum, fixed dollar amount that the insurance company will pay toward vet bills in any given year. The reimbursement rate refers to the percentage of each vet bill that the company will cover.
Most insurers offer a fairly high reimbursement level for veterinary bills — typically 70%, 80% or 90%. Pet owners are responsible for the remaining 30%, 20% or 10% (known as the coinsurance). There are a few providers that offer 100% reimbursement but you’ll pay a very high premium for this benefit.
Age caps
Also, many insurers set age limits on coverage. This means that after your pet reaches a certain age, you’ll be unable to renew its policy. Likewise, some pet insurance companies won’t issue new policies for pets that are over a certain age — such as 10 years.
Deductibles
Pet insurance policies have annual deductibles you must meet before coverage kicks in. Policyholders can choose the deductible amount they are comfortable paying. Typical choices are $250, $500 and $1,000, although a few insurers also offer policies that have no deductible (at high premiums). As a rule, the lower the deductible, the higher the premium.
Is pet insurance worth it?
Pet insurance coverage is unlikely to pay off if your pet has a typical medical life, as in occasional non-catastrophic illnesses or accidents.
This type of insurance is most likely to pay off financially if your animal develops a serious — and probably long-term — medical condition, such as cancer, or suffers a catastrophic accident that requires major surgery. That said, insurance may be less suitable if you’re hesitant to put a very ill animal through chemotherapy or serious surgery, especially if they’re old.
Conversely, pet insurance may provide an emotional payoff that justifies getting it (despite the low odds that you’ll recoup what you spend on premiums, deductibles and coinsurance) if you’re a pet owner who’s likely to take any step to save your animal, regardless of its age or the seriousness of the treatment.
Summary of Money’s Guide to Pet Insurance Coverage
Most pet health care plans cover the cost to treat unexpected injuries, accidents and illnesses. This includes surgery, medication, tests and emergency care and exam fees.
The details of your pet insurance policy will depend on the type of coverage and the provider you choose. There are two main pet insurance coverage options:
- Accident and illness coverage will cover accidents and vet-diagnosed sickness or disease.
- Accident-only coverage will cover only injuries.
You can also add riders to cover services like routine care, end-of-life expenses, alternative therapy and behavioral modification.
But is pet insurance worth it? It depends. Many policyholders will spend their pet’s lifetime paying premiums without breaking even and may regret doing so if the pet remains relatively healthy. On the other hand, a policy could give pet owners peace of mind knowing they wouldn’t have to choose between their financial stability and their pet’s health.
