What Does Pet Insurance Cover?

According to Spot Pet Insurance, an emergency veterinary surgery can set you back anywhere from $1500 - $5000. Even a short-term hospitalization might burn a $2500-sized hole in your wallet. And that’s before you even consider the cost of X-rays or the medications needed to treat your furry friend. 

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Thankfully, you can avoid those panic-inducing numbers with a good pet insurance plan. Much like human health insurance, your pet insurer will pay a set amount based on your policy parameters.

Unfortunately, understanding the ins and outs of pet health insurance can be just as confusing as regular health insurance. Follow along below for a guide on choosing between the different types of insurance coverage to fit the needs of your pawed pals. 

Types of Pet Insurance Coverage

In short, pet insurance plans typically come in two main types: accident and illness coverage and accident-only coverage. 

Accident and illness coverage provides more comprehensive coverage. It pays for various treatments if your pet gets injured or sick. Your policy could come in handy if Boxer tears through your chocolate stash or your cat needs kidney disease treatment. 

If you need to be more frugal, accident-only pet insurance will cover treatments for accident-related injuries. That means your cat will get treatment and stitches after a scuffle with the neighboring stray. However, the policy won’t help Mittens with her chronic arthritis.

Additionally, some insurance providers break off certain preventative care services for pets into add-on plans or require you to pay out of pocket. That means wellness checkups, X-rays, or even microchip implantations could still depend on your personal funds. It’s not all bleak, though. Many of the best pet insurance providers have your back and bundle various extra services. 

What Do Pet Insurance Plans Cover?

Pet insurance plans vary widely in coverage, so comparing providers's crucial. Each company offers a unique list of covered injuries, illnesses, procedures, and payout limits. This overview will give you a solid starting point as you research your options for protecting your furry friend.

Accidents and Injuries

Pet insurance often covers many accidents and injuries, providing crucial support when your pet faces unexpected harm. Commonly covered incidents include:

• Torn ligaments (e.g., ACL ruptures)
• Bite wounds and lacerations
• Broken bones and fractures
• Cuts and abrasions
• Swallowed objects requiring surgical removal
• Toxic ingestions (e.g., chocolate, household chemicals)
• Sprains and strains
• Burns or injuries from accidents like being hit by a car

Orthopedic Conditions

Orthopedic issues can lead to significant veterinary expenses, especially in certain breeds. Many plans cover:

• Bone fractures and dislocations
• Osteosarcoma (bone cancer)
• Hip dysplasia
• Intervertebral disc disease (IVDD)
• Cruciate ligament injuries
• Patellar luxation (dislocated kneecap)
• Elbow dysplasia

Common Illnesses

From minor infections to more persistent issues, pet insurance typically covers a range of common illnesses, such as:

• Ear, skin, and eye infections
• Diarrhea and vomiting
• Urinary tract infections
• Dental issues (e.g., tooth infections, extractions)
• Respiratory infections
• Gastroenteritis
• Pancreatitis

Chronic Illnesses

Chronic illnesses in pets often require ongoing care and comprehensive coverage plans for:

• Allergies (environmental and food-related)
• Arthritis and joint pain
• Digestive disorders (e.g., inflammatory bowel disease)
• Seizures and epilepsy
• Skin conditions (e.g., dermatitis, hot spots)
• Hypothyroidism
• Diabetes management

Serious Illnesses

Serious illnesses can lead to extensive treatments and long-term care. Many top pet insurance plans cover the following:

• Cancer (including chemotherapy and radiation therapy)
• Heart disease (e.g., heart failure, cardiomyopathy)
• Kidney and liver disease
• Diabetes
• Autoimmune disorders
• Chronic respiratory conditions (e.g., asthma)

Infectious Diseases and Parasites

Coverage often extends to infectious diseases and parasitic infections, including:

• Lyme disease
• Parvovirus (Parvo)
• Kennel cough
• Feline leukemia virus (FeLV)
• Distemper
• Heartworm disease
• Tick-borne diseases
• Leptospirosis

Breed-Specific and Hereditary Pet Conditions

Some breeds are prone to specific health issues, which many plans cover, such as:

• Hip dysplasia
• Intervertebral disc disease (IVDD)
• Eye disorders (e.g., cataracts, progressive retinal atrophy)
• Blood disorders (e.g., von Willebrand disease)
• Brachycephalic syndrome (respiratory issues in flat-faced breeds)
• Heart defects (e.g., mitral valve disease)
• Cushing’s disease

Behavioral Therapy

Behavioral issues can be challenging and expensive to treat. Coverage might include:

• Aggression management
• Destructive chewing or scratching
• Excessive barking or meowing
• Separation anxiety
• Compulsive behaviors (e.g., tail chasing, licking)
• Noise phobias (e.g., thunderstorms, fireworks)

Testing and Diagnostics

Accurate diagnosis is essential for effective treatment. Pet insurance often covers:

• Veterinary exam fees
• Blood tests and lab work
• X-rays and ultrasounds
• CT scans and MRIs
• Endoscopies and biopsies
• Allergy testing
• Echocardiograms

Prescription Medications

Managing health conditions usually requires medication. Coverage generally includes:

• Medicine for chronic illnesses (e.g., insulin for diabetes)
• Antibiotics for infections
• Pain management (e.g., NSAIDs, opioids)
• Anti-inflammatory drugs
• Heart medications (e.g., beta-blockers, ACE inhibitors)
• Seizure control medications
• Thyroid medications

Prescription Food and Supplements

For pets with specific health and dietary needs, many insurance plans cover:

• Prescription diets (e.g., for kidney disease, weight management)
• Supplements for joint health (e.g., glucosamine, chondroitin)
• Omega-3 fatty acids for skin and coat health
• Digestive aids (e.g., probiotics)
• Urinary health diets

Holistic and Alternative Procedures

Some plans also cover alternative pet treatments that support overall well-being, such as:

• Acupuncture
• Chiropractic care
• Laser therapy
• Hydrotherapy
• Physical rehabilitation
• Homeopathic treatments
• Massage therapy

Wellness Procedures

Although often available as an add-on or separate plan, some insurance providers offer coverage for preventive care for pets, including:

• Routine wellness exams
• Vaccinations (e.g., rabies, distemper)
• Flea, tick, and heartworm prevention
• Spaying and neutering
• Microchip implantation
• Dental cleanings
• Annual blood work

Please note: While these are common coverages, specific details can vary between insurance providers and plans. Always carefully review policy documents and consult with insurance representatives to understand exactly what is covered for your pet's unique needs.

Accident and illness coverage is the most comprehensive pet health insurance plan, covering everything from routine veterinary expenses to chronic illnesses in pets and hereditary pet conditions.

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Policy Exclusions and Limitations

Just like how you wouldn’t expect your health insurance to cover a spa day, there are certain things pet insurance just won’t pay for. If you’ve ever been caught off guard by a veterinary expense, you know how important it is to understand what’s not covered. So here are some common exclusions you’ll likely encounter:

• Pre-existing conditions (especially chronic or incurable issues)
• Hereditary pet conditions
• Experimental or investigational procedures
• Cosmetic procedures (e.g., ear cropping or dental caps, crowns, and implants)
• Elective procedures (such as dewclaw removal)
• Behavioral therapy
• Grooming appointments
• Regular food and dietary supplements
• Herbal and herbal-like products (including Cannabis (CBD) and food products)
• Breeding, pregnancy, whelping, or nursing expenses
• Anal sac (gland) expression, treatment, and resection (when no infection is present)
• Dental cleanings (unless treating a covered illness or covered by an applicable endorsement)
• Funeral services and memorial items (e.g., urns, caskets, burial plots/fees)
• House call fees and travel expenses (to and from the veterinarian's premises or hospital)
• Non-medical and non-veterinary costs (e.g., dog or cat licensing fees, administrative fees, medical records expenses)
• Organ or heart valve transplants

Your insurer may also have restrictions on the types of pets it covers and the age range for coverage. For example, most pet insurance companies stick to the basics—dogs and cats. So, if you’ve got a rare pygmy chameleon, don’t count on the insurer footing the bill. Many insurers won't cover pets younger than six weeks old, and they often cap initial enrollment between eight and 14 years of age.

Additional Insurance Coverages and Benefits

Missing out on routine checkups and alternative pet treatments like acupuncture and chiropractic care? If your base policy excludes certain benefits you want, you may be able to purchase additional coverage for:

• Preventative and wellness care: Coverage for routine checkups, vaccinations, dental cleanings, and parasite prevention.
• Behavioral therapy: Treatment for issues like aggression, anxiety, or compulsive behaviors.
• Final expenses: Assistance with cremation, burial, or other end-of-life services.
• Rehabilitation or physical therapy: Coverage for recovery sessions after surgery or injury, including hydrotherapy and physical rehab.
• Alternative treatments: Options like acupuncture, chiropractic care, and laser therapy for pain management or holistic wellness.
• Boarding fees: You may be reimbursed for pet boarding if you are hospitalized for an extended period and cannot care for your pet.

You can often add liability coverage to your pet insurance, protecting you if your pet damages someone's property or injures another person. Before buying this extra coverage, check your homeowner's insurance policy—it may already include this protection. Take the time to review your existing coverage to avoid paying for duplicate insurance. 

Cost Factors and Affordability

According to the North American Pet Health Insurance Association (NAPHIA) 2024 highlights, these are the average annual accident and illness pet insurance premiums:

Your insurance policy may cost more or less than average based on several factors, including:

• Pet type and breed. Dogs generally tend to cost more to insure than cats. Some breeds are prone to certain conditions, increasing the insurer’s risk.

• Pet size. Larger animals usually cost more to insure.

• Pet age. Older pets generally need more medical care, making them more expensive to insure.

• Insurance plan type. Accident and illness coverage costs significantly more than accident-only coverage because it covers a broader range of conditions.

• Pre-existing condition coverage (if included in your policy). Coverage for a pre-existing condition, if available, can result in a higher premium or deductible.

• Your deductible. Policies with a higher deductible usually have a lower premium (and vice versa). 

• Your reimbursement level. The more your insurer promises to reimburse you for covered treatment (usually between 70-90%), the higher your premium.

• Your location. Veterinary care costs vary from ZIP code to ZIP code.

If you’re on a tight budget, there are several things you can do to keep your pet insurance premium in check. Raman Singh, certified financial planner (CFP®) and pet insurance policy owner, advises assessing your potential insurance cost before you welcome a new cat or dog into your home. "If you are considering getting a pet, one way to lower your costs is to research the breed you are getting."

For those already with pets, Singh suggests that you "consider increasing your deductible and copays, paying premiums annually, lowering or adjusting your insurance benefit amount, or removing any optional riders on the policy” to save money.

Choosing the Right Insurance Plan for Your Pet

Selecting the best pet insurance policy can feel overwhelming, but focusing on key factors will help you make an informed decision. Here's what to consider:

• Plan coverage: Scrutinize the policy details to ensure it covers your pet's specific needs. Look for exclusions that might expose you financially, especially for breed-specific conditions.

• Cost structure: Evaluate how the plan's monthly or annual premium fits into your budget. Consider the deductible amount and whether it's annual or per-incident. Also, check the reimbursement percentage – higher percentages mean lower out-of-pocket costs for you.

• Claims process: Understand how you'll be reimbursed. While most insurers require upfront payment and filing for reimbursement, some offer direct vet payments. Investigate the average processing time and the company's claim approval rate.

• Customer service: Before committing, test the insurer's responsiveness by calling their service line, noting wait times and the helpfulness of representatives. Then, browse reviews on independent sites like Trustpilot or the Better Business Bureau for unbiased customer experiences.

• Company reputation: Research the insurer's financial stability and history. Look for any red flags, such as frequent customer complaints, lawsuits, or financial instability that could affect its ability to pay claims.

• Policy specifics: Pay attention to waiting periods before coverage begins, especially for conditions like hip dysplasia or ligament issues. Understand any coverage limits – whether they're annual, lifetime, or per-incident.

• Wellness coverage: Some plans offer preventive care coverage for vaccinations, dental cleanings, and routine check-ups. Decide if this additional coverage is worth the extra cost for your pet's needs.

• Age and pre-existing conditions: Be aware that older pets or those with pre-existing conditions may face limited coverage options or higher premiums. Start insuring your pet early for the most comprehensive coverage.

• Multi-pet discounts: If you have more than one pet, inquire about multi-pet discounts, which can provide significant savings.

• Customization options: Look for plans that allow you to adjust coverage levels, deductibles, and reimbursement percentages to tailor the policy to your needs and budget.

Is Pet Insurance Worth It?

Yes, absolutely. Pet insurance offers a peace of mind you might underestimate if this is your first time taking financial responsibility for a pet. Here are some other reasons why pet insurance is worth it: 

• Aging and chronic conditions: As your furry friend ages, they're more likely to develop ongoing health issues like arthritis or diabetes. With insurance, you can address these concerns early, potentially extending your pet's life without straining your finances.

• Unexpected emergencies: Life is unpredictable, and so are pet-related emergencies. From accidents to sudden illnesses, having coverage means you can focus on your pet's health rather than worrying about the cost of treatment.

• Routine care costs: Even if long-term health concerns seem distant, remember that initial pet ownership comes with its own expenses. These costs can add up quickly in the first few months, from regular check-ups to spaying or neutering.

• Financial safety net: If you're on a tight budget, pet insurance is a buffer against unexpected veterinary expenses. It allows you to make decisions based on your pet's needs rather than financial constraints.

• Consistent care: With insurance, you're more likely to seek veterinary attention promptly, potentially catching issues early when they're more treatable and less expensive.

How to Apply for Pet Insurance

Ready to get your pet covered? Here’s how to lock in the best insurance for your whiskered ones:

1. Set a budget: Determine how much you can comfortably afford monthly and annually. Consider both premium costs and potential out-of-pocket expenses like deductibles and co-pays.

2. Assess your pet's needs: Evaluate your pet's age, breed, activity level, and health history. Research potential hereditary conditions common to your pet's breed. This information will help you choose appropriate coverage levels.

3. Research potential insurers: Ask your veterinarian, family, and friends for recommendations. Compare top-rated pet insurance providers like CarePlus by Chewy or Embrace Pet Insurance, paying attention to customer reviews and satisfaction ratings. Examine each company's website for policy details, coverage options, and exclusions.

4. Compare multiple quotes: Request quotes from several insurers, ensuring you're comparing similar coverage levels, deductibles, and reimbursement percentages. Look for any discounts you might qualify for, such as multi-pet or annual payment options.

5. Understand the coverage: Familiarize yourself with key terms like waiting periods, exclusions, and benefit limits. Pay special attention to how pre-existing conditions are defined and handled.

6. Complete the application process: Once you've chosen a provider, complete the required forms accurately. Be prepared to provide your pet's medical history and possibly recent veterinary records.

7. Review the policy documents: Carefully read through all policy documents before enrolling. Pay close attention to claim procedures, reimbursement timelines, and any breed-specific exclusions.

8. Prepare for the waiting period: Most plans have a waiting period before coverage begins, typically ranging from a few days for accidents to several weeks for illnesses. Use this time to familiarize yourself with the claim process and set up any required online accounts.

9. Schedule a check-up: Consider taking your pet for a thorough veterinary examination soon after your coverage begins. This can establish a baseline for your pet's health and help identify any potential issues early.

As your cat or dog ages, it becomes harder to insure them. However, if you pay the premium, your current insurer will likely keep your policy intact indefinitely. While you don’t have to stick with the same pet insurance company forever, choosing carefully from the start is a good idea. 

Singh offers this last nugget of advice: “Pet insurance effectively mitigates significant financial risks associated with pet injuries or illnesses. However, it's crucial to prioritize annual wellness exams to stay informed about your pet's health status.”

In addition to insurance, Singh suggests setting up a monthly pet savings account. This can give you a financial cushion if your pet faces an unexpected illness or injury. By combining insurance with a savings plan, you’re taking a proactive approach that ensures your pet’s health and wallet are in good shape.