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What Does Pet Insurance Cover?
By Ingrid Case MONEY RESEARCH COLLECTIVE
Most pet insurance plans help pay for accidents and illnesses, but coverage varies more than many pet owners realize.
Pet insurance can help offset expensive vet bills, but it doesn’t cover everything.
Navigating the fine print can be a major hurdle, and may explain why so few pet owners see it as a must-have, even as pet care costs climb.
A new study by Money and Healthy Paws Pet Insurance found that a vet bill below $1,000 would trigger “significant stress” for about half of pet owners, and one in five would feel financial strain by any amount. Yet only about 4% of U.S. cats and dogs are insured, according to the latest data from the North American Pet Health Insurance Association (NAPHIA).
Still, the industry is growing rapidly, and there are more options available than ever. Here’s a breakdown of what’s typically covered, what’s not, and how to choose the right fit for your pet.
What’s covered under pet insurance?
Most pet insurance plans are designed to help pay for unexpected vet bills related to accidents, injuries and illnesses. Costs for surgery, medication, X-rays, blood work and emergency care are typically included.
That said, coverage isn’t guaranteed for every vet bill. Insurers may deny a claim if they 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.
Here’s a breakdown of the injuries and illnesses most pet insurance providers will cover:
What doesn’t pet insurance cover?
Coverage varies by insurer, but most pet insurance plans don’t cover:
Pre-existing conditions
Pre-existing conditions, or health issues your pet had (or, in some cases, showed symptoms of) before coverage began typically aren’t covered. This exclusion also applies to new 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 make sure to dig into the details before you buy a policy.
Routine and preventative care
Most standard pet insurance plans don’t cover elective procedures like grooming and nail trimming, or routine care like vaccinations and teeth cleaning.
Owner-caused injuries and neglect
Pet insurance won’t cover injuries or illnesses that result from the owner’s own actions, such as intentionally harming a pet or subjecting them to organized fighting or racing.
Veterinary bills related to breeding or breeding-related complications are also generally excluded from standard pet insurance policies.
What are the different types of pet insurance?
Most pet insurance companies offer two coverage options: accident-only and accident and illness coverage. Some companies also sell wellness add-ons, but these plans typically cover routine care and aren’t considered pet insurance.
1. Accident and illness plans
Accident and illness plans (also called “comprehensive policies”) cover a wide range of illnesses, from minor issues like vomiting and diarrhea — even if the cause is unknown — to serious conditions like cancer.
Covered services typically include diagnostic testing (X-rays, MRIs and blood work), hospital stays, surgery, medications, chemotherapy and alternative therapies (acupuncture, laser and stem cell treatment.)
Coverage for cancer and specialty care is standard with most accident and illness plans. Here are a few other conditions these policies typically cover:
Coverage limits and restrictions
Like other medical conditions, hereditary and congenital conditions are generally covered only if they’re first diagnosed after your policy takes effect. If a pet showed signs of one of these conditions before enrollment, insurers usually classify it as pre-existing and exclude it from coverage.
Some pet insurance policies only cover specific conditions after a waiting period has elapsed. A policy may only cover surgery for hip dysplasia if the condition is diagnosed at least six months after the policy takes effect, for example.
Age-based restrictions can apply as well. 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 plans
As the name suggests, accident-only policies reimburse treatment for injuries caused by accidents. The scope of coverage is narrow compared to comprehensive plans but premiums are more affordable, you can enroll senior pets, and waiting periods are typically shorter. Unlike the usual two-week waiting period for accident and illness plans, accident-only plans are often ready to use within 24 hours.
Still, your initial rate may be influenced by how accident-prone your pet’s breed is. Labrador retrievers, for instance, often have higher premiums because they’re known for swallowing things they shouldn’t.
Here’s a quick look at what accident-only coverage typically reimburses — and what it usually doesn’t:
3. Wellness plans
Wellness coverage, sometimes called preventative care coverage, helps cover the cost of routine veterinary care and, in some cases, grooming, training and other services. This plan is usually offered as an add-on or “rider” to an accident and illness policy, though some insurers, animal hospitals and pet care stores offer it as a standalone plan.
In addition to wellness riders, pet insurers add-ons for things like end-of-life expenses, lost or stolen pet recovery, pet boarding while the owner is hospitalized and liability coverage. Some insurance companies bundle these with wellness coverage, while others sell them separately.
Comparing pet insurance plans
The list below, while not exhaustive, can help you compare the benefits of each pet care plan and guide your choice.
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