What Does Pet Insurance Cover?

In this article, we will discuss what situations pet insurance covers, including the things it doesn’t. Accidents and injuries can be emotionally devastating when they leave your pet in harm’s way, but they can be financially devastating without pet insurance. By not carefully selecting the right pet insurance, you can find yourself paying thousands of dollars out of pocket for an unexpected accident or illness.

Unless you invest in a wellness rider, most pet insurance is only designed for unexpected injuries or illnesses and not preventative care.

Comparison of pet insurance plans coverage

There are different pet insurance plans for common household pets, namely cats and dogs.

The 2023-2024 APPA National Pet Owners survey found that almost 87 million households had a pet, which equates to 66% of American households. The majority of pet owners have a dog or a cat.

The price will vary for each based on factors like age, size, and current health condition. Whether you have a dog or cat, there are three main pet insurance plans from which to choose with increasing costs:

1. Accident only
2. Accident and illness
3. Wellness

In general, pet insurance covers medical costs associated with accidents or illnesses. The type of plan you have will determine exactly what coverage is available to you and your pet.

Accidents & illnesses

Most pet insurance policies provide coverage for accidents and injuries. Accidents and injuries include things such as:

• Bite wounds
• Broken bones
• Lacerations
• ACL ruptures

Chronic illnesses

Chronic illnesses are unexpected illnesses that aren’t necessarily cured but are simply managed throughout your pet’s lifespan. A common illness like an ear infection or a urinary tract infection is something that is treated quickly, whereas things like allergies or digestive problems might require ongoing treatment.

Qualifying chronic illnesses would likely fall under an accident and illness policy in these cases. Some examples of coverage include:

• Allergies
• Seizures
• Digestive issues
• Skin conditions

Hereditary conditions

Each breed of animal comes with certain risks for genetic conditions. For example, Labradors and Golden Retrievers often have pre-existing hip and elbow dysplasia. Pugs are brachycephalic, which is why they often wheeze when they breathe, but it also means they are prone to brachycephalic obstructive airway syndrome.

If you have a pet insurance policy, it might cover hereditary conditions such as:

• Eye disorders
• Hip or elbow dysplasia
• Blood disorders

Testing and diagnostics

Pet insurance policies will offer coverage for testing and diagnostics related to qualifying accidents or injuries. Examples include:

• Blood tests
• Ultrasounds
• X-rays
• MRI’s
• CT scans

Let’s say you have an older cat and bring her in for her regular wellness exam. During this exam, the veterinarian suspects your cat might have a tumor, so they recommend an x-ray to look for signs of cancer as well as blood tests.

Assuming this is not a pre-existing condition, even though you went to the vet for a wellness exam, the X-ray and blood test costs would be covered under an accident and illness policy.

Procedures

General pet insurance policies will cover procedures relating to the results of testing and diagnostics. But you have to ensure that the accident or illness that caused the issue is covered by your policy.

Procedures include:

• Nursing care
• Hospitalizations
• Endoscopies
• Surgeries
• Chemotherapy

Using the same example of the cat above, if the results of the tests determined that there was a tumor, the surgery to remove that tumor or the chemotherapy to try and treat cancer would be considered qualifying procedures under most accident and illness pet insurance policies.

Holistic and alternative procedures

General pet insurance policies will often cover holistic and alternative procedures as these can be qualifying forms of treatment for accidents or illnesses. Some examples include:

• Acupuncture
• Laser therapy
• Chiropractic adjustments

Wellness procedures

Wellness procedures refer to your general preventative care and all of the costs therein. Most policies don’t include coverage for wellness procedures, but you can add wellness coverage to an accident and illness policy.

• Routine wellness exams (like your annual doctor visits)
• Flea and tick prevention
• Heartworm medication
• Vaccines

Behavioral therapy

Some animals might struggle with behavioral problems or anxiety issues and be prescribed things like anxiety medication or behavioral therapy. Depending on the terms of your policy, behavioral therapy and any Associated medications for behavioral problems may be covered.

Additional care

Additional care can include preventative healthcare, vaccinations, spaying, neutering, or routine checkups.

Prescriptions

Some pet policies include the cost of prescriptions assuming they are prescribed for a qualifying accident or illness. If your policy does not include coverage for prescription medications, you might be able to add a rider for prescriptions.

Pre-existing conditions

Your pet might have a pre-existing condition, which has already been diagnosed when you apply for pet insurance.

In general, pet insurance policies will not apply to any pre-existing conditions. However, you might be able to find specific policies that are more expensive but provide coverage for pre-existing conditions.

Cosmetic procedures

General pet insurance policies don’t extend to cosmetic procedures. Cosmetic procedures are any form of surgery or treatment you have done simply for aesthetics or cosmetic purposes but not for health reasons.

Some examples include:

• Prosthesis after neutering
• Ear cropping
• Tail docking

Breeding costs

If you have a pure breed and you want to sell their offspring, general pet insurance policies will not cover breeding costs.

Costs can include:

• Basic breeding tests such as X-rays and thyroid tests
• Heart tests
• Liver evaluations
• Health certifications
• Immunization boosters
• Stud fees
• Transportation costs
• Shipping or implantation costs

Grooming

Grooming is generally not covered by basic pet insurance policies. Grooming includes things like bathing, hair treatments, or nail treatments.

Supplements

Supplements are typically anything you provide for your pet that is not a prescription. If it’s not something a veterinarian prescribes for an accident or illness related to your policy, it will likely not be covered.

Experimental treatment

Experimental treatment can include any form of diagnosis or treatment that is not currently accepted by the state veterinary medical board where you live. If you opt for an experimental treatment, it will generally not be covered by your pet insurance policy.

Types of pet insurance plans & what they cover

There are three main types of pet insurance policies:

1. Accident-only coverage: Accident-only coverage is the most basic and only applies to, as the name suggests, accidents.
2. Accident and illness coverage: The next level of care provides coverage against unexpected illnesses.
3. Wellness coverage: Wellness coverage is much more comprehensive and is something you attach to an accident and illness coverage policy, so it gives comprehensive care no matter what happens to your pet in the future.

According to 2022 industry data from the NAPHIA, there are 24 companies offering pet insurance, so you have lots of options for optional coverage and affordable plans.

Accident only coverage

Accident-only coverage is one of the most affordable plans because it’s there only for an unexpected accident. It is also one of the most limited. It can help cover the cost of the following:

• Diagnostic tests
• Hospitalizations
• Surgical procedures
• Medications

Assume your dog gets in a fight with another dog. Your dog walks away with a torn ligament and some cuts and bruises on their face. Your accident-only policy would cover medical expenses for that fight, but if they end up diagnosed with cancer or severe allergies, accident-only coverage won’t pay for tests, procedures, or medication.

Things like cancer and allergies are considered illnesses, whereas an attack is an accident.

Accident and illness coverage

So, if you want to ensure your pet is protected against allergies, cancer, and unexpected dog fights, you want accident and illness coverage.

Accident and illness coverage is the most common pet insurance policy. It provides coverage for chronic illnesses, problems related to illnesses, problems related to accidents, as well as hereditary conditions. It doesn’t include the cost of regular check-ups, and it is slightly more expensive compared to other categories.

Let’s say you have a boxer, and he tears his ACL. In that case, your accidents and illnesses policy would likely cover the following:

• Diagnostic tests
• Hospitalizations
• Surgical procedures
• Medications

Now let’s say later that year, your boxer struggles with severe allergies that cause swelling around his eyes and ear infections. In that case, the same policy would extend to the same costs for tests, procedures, and prescriptions.

Wellness coverage

Wellness coverage is an optional plan that provides insurance coverage for routine and preventative care. This is something you typically add to an accident and illness coverage policy.

The American Pet Products Association’s 2021-2022 National Pet Owners Survey listed the average annual costs for a surgical vet appointment at $458 for a dog and $201 for a cat.

If you have a cat and they get in an accident, your accident and illness coverage policy would cover diagnostic tests, any surgical procedures, x-rays, blood work, and medications, but the wellness coverage would extend to things:

• Regular vet checkups
• Flea and tick medication
• Heartworm prevention (for dogs)
• Vaccinations

Does pet insurance cover spaying or neutering?

In most cases, pet insurance plans generally do not cover spaying and neutering because this is more of an elective operation rather than a medical necessity. If you have a Wellness Plan or you have a wellness rider, it will likely include preventative care and routine care, including spaying and neutering.

Does pet insurance cover dental care?

Most accident and illness plans do not cover dental care unless it falls under a qualifying accident or illness. Some plans are categorized as preventative or comprehensive, and these extend to dental procedures.

Does pet insurance cover vaccines?

This depends on the plan and the provider. Some pet insurance providers offer wellness riders which extend to the costs of vaccinations and general wellness appointments. Others do not cover vaccines at all.

Does pet insurance cover pre-existing conditions?

Generally, pet insurance for accidents and illness does not cover pre-existing conditions, especially those that are not curable. Some pet insurance companies specialize in pre-existing pet insurance and others allow you to add additional coverage for pre-existing conditions.

Does pet insurance cover surgery?

In general, your policy will likely cover surgery for qualifying situations such as accidents or illnesses. Every provider’s plan differs slightly in terms of coverage, and you will still have to pay your deductible and whatever percentage of the total costs you are responsible for under your “reimbursement percentage” terms, something we will cover later.

Does pet insurance cover medication?

Every provider’s pet insurance plan will differ slightly in terms of the coverage offered. If your pet insurance policy does not cover prescription medications, you might be able to purchase a rider or optional coverage package specifically for prescription medications.

If your policy does cover prescription medications, they must be FDA-approved and prescribed by a licensed veterinarian specifically to treat a condition covered under your policy.

Does pet health insurance cover cancer treatments?

Each provider’s plan differs slightly. More comprehensive pet insurance policies will cover cancer treatment as it falls under the category of qualifying illnesses so long as it’s not a pre-existing condition.

If it is a pre-existing condition, treatment costs may not be covered unless you buy additional riders.

Does pet health insurance cover diagnostics?

Pet health insurance will generally cover diagnostics and any subsequent treatments so long as the diagnostics are for eligible illnesses or accidents. You can check your policy to verify eligibility.

Does pet health insurance cover physical therapy?

Some policies will cover physical therapy so long as it is related to an eligible illness or accident. This physical therapy must be performed by a licensed animal physical therapist, if it is covered, in order to qualify for reimbursement.

How does pet insurance work?

With pet insurance, you can generally choose any veterinarian in your area without network restrictions. The reality is you will still be on the line for the upfront cost of care, but you’ll be reimbursed within a matter of weeks or months, depending on your company.

1. When you take your pet to the vet for covered procedures or treatments, you generally have to pay out of pocket for the costs.
2. Then you submit an invoice or receipt for what you paid to your pet insurance provider after the appointment.
3. Your pet insurance provider will review the claim and reimburse you where appropriate.

How much does pet insurance cost?

In order to understand the cost of pet insurance, you have to know three key terms:

1. Annual Reimbursement Limit: This is the maximum amount your pet insurance company will reimburse you each year for total pet costs.
2. Annual Deductible: This is the minimum amount you have to pay out of pocket before your pet insurance company will begin annual reimbursements.
3. Reimbursement Percentage: This is the percentage that your pet insurance company will reimburse you once you meet your deductible.

The cost of all three of these factors can be adjusted to fit your budget but bear in mind that adjustments to any one of those will change your monthly insurance cost.

The NAPHIA’s industry report for 2023 found that the average premium for pet insurance is $32 per month.

Let’s look at a quick example of a 13-year-old domestic long hair cat in New York:

In the table above, you’ll notice that there isn’t a significant difference in the monthly cost between the annual reimbursement limit of $10,000 versus $15,000 when all other factors are the same.

What increases the monthly cost the most is your annual deductible. So if you can choose to set aside a minimum of $500, $750, or $1,000 to cover unexpected pet care costs, it can keep your monthly costs low without compromising a high annual reimbursement limit or a high reimbursement percentage.

Below is the same example but based on a 5-year-old male Puggle dog:

Dogs are the most commonly insured pet, according to the NAPHIA’s industry report for 2023.

Now let’s look at how that impacts a real-life situation.

For a cat: Older cats are more likely to suffer from kidney disease or leukemia. The cost of blood work, tests, and medication for kidney disease amounts to $250 every 2 months.

Additional X-rays to look for leukemia are $85 each, and the blood work is $150 each time. Other costs might include prescription kidney diet food at $75 per month.

Without pet insurance, you might have to pay $2635 for kidney disease management, annual cancer X-ray/blood work, and kidney diet food, not including regular care and appointment costs.

With pet insurance, you might have to pay $500 to reach your annual deductible and $427 for the 20% you owe based on an 80% reimbursement percentage. $927 is much more affordable than $2635, especially if those are unexpected, ongoing costs for several years. This becomes even more important as your pet gets older because they are statistically more likely to develop multiple conditions requiring tests, diagnostics, and treatment.

Where you live will slightly influence the cost because the insurance rates are tied to the average cost of pet care in that state.

According to NAPHIA’s industry report for 2023, the majority of pets are insured in California, New York, and Florida.

Optional Coverages

There are optional coverage plans that you can add to your pet insurance, depending on the provider. Two of the most common are exam fees and prescription drugs. The cost for each is contingent upon the type of policy you are taking out and the type of pet you are covering.

Exam Fees

All accident and illness exam fees can be covered by adding this optional coverage to your policy. Using the cat example above, this optional policy would add $4 per month to your insurance.

Prescription Drugs

Similarly, you can add all the costs of prescription drugs for ongoing care with an optional coverage policy which, using the cat example above, adds $4.28 to your monthly cost.