A Complete Guide to Pet Insurance Coverage

A Complete Guide to Pet Insurance Coverage

Information about A Complete Guide to Pet Insurance Coverage

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Pet insurance pays for unexpected veterinary bills so you can focus on getting your dog or cat the medical care they need. But pet insurance plans vary in what they cover and how they pay out, so it’s important to understand how your policy works before you buy.

What is pet insurance?

Like human health insurance, pet insurance covers the cost of medical care. If your furry friend gets seriously sick or injured, the vet bills for treatment can add up fast. A pet insurance policy can help you pay them.

Who’s eligible for pet insurance?

Most pet insurance companies insure only dogs and cats. The ASPCA insures horses too, while Nationwide sells plans for birds, snakes, rabbits and other “exotic” pets.

Some insurers accept new pets only within certain age limits. Generally, puppies and kittens must be at least 6 to 10 weeks old, depending on the insurer.

Although some plans have no maximum age limits, others restrict coverage for older pets or cut off first-time enrollment at ages 8 to 14. Once you’re enrolled, though, most plans will offer pet insurance coverage for life as long as you continue paying the premiums.

Some plans also require your pet to have seen a vet recently, or ask that your pet undergo an exam before they’ll sell you a policy.

Waiting periods

Pet insurance plans usually have waiting periods for coverage to begin after you sign up. The coverage for injuries from accidents may begin after just a few days. The waiting period for illness coverage is often longer, such as 14 or 15 days.

There might also be waiting periods of several months to a year for orthopedic problems such as cruciate ligament issues or hip dysplasia.

If your pet needs treatment during these waiting periods, the plan will pay nothing — and any issues that arise will be considered pre-existing conditions going forward.

What does pet insurance cover?

The most common type of pet insurance plan covers both accidents and illnesses. So if your dog is hit by a car or gets a urinary tract infection, his treatment would be covered, up to your plan limit.

Some pet insurance companies also offer accident-only policies, which tend to be cheaper. An accident-only policy can help if your cat swallows a toy and needs surgery, but won’t pay a cent if she gets sick.

You can expect most accident and illness plans to cover:

  • X-rays, ultrasounds and other diagnostic tests.

  • Treatment for illnesses like cancer or infections.

  • Prescription medications.

But beyond these basics, coverage can vary quite a bit among plans. Here’s what to look out for:

Alternative and rehabilitative treatment. Some plans cover physical therapy and a wide range of alternative treatments, such as acupuncture and chiropractic care. Others cover only some of these, don’t cover them at all or limit coverage to the most expensive plans. There’s no standard definition of alternative care, so read the details to find out exactly which treatments your pet is eligible for.

Behavioral therapies. If your vet recommends treatment for issues such as aggression or compulsive behavior, some plans will cover the expense, and some won’t. Others may charge extra for a package that includes this coverage.

Congenital or hereditary conditions. A congenital condition is an abnormality your pet is born with that can lead to later complications. A hereditary condition, such as hip dysplasia or patellar luxation, is passed down to an animal from its parents. Many plans will cover such conditions as long as your pet didn’t show symptoms before you bought the policy. Other plans may limit coverage for these conditions.

Exam fees. Some plans reimburse you for procedures and drugs but don’t cover exam fees when your pet is sick or injured. Others may charge extra if you want these fees covered.

Prescription diets and supplements. If your vet prescribes a certain type of food or supplement to treat your pet’s medical condition, some plans will pay for it. Others won’t, or will charge extra for the coverage.

Final expenses. The end of your pet’s life may bring not only heartbreak but also expenses associated with euthanasia, cremation or burial. Depending on your plan, pet insurance may cover some or all of these costs.

What’s not covered by pet insurance?

Most pet insurance plans won’t cover:

Pre-existing conditions. A pre-existing condition is a medical problem that your pet had before you bought the policy or that cropped up during the waiting period. These are almost never covered by any pet insurance plan. However, some policies will cover past conditions that have been cured for a certain number of months.

A word of warning: If you decide to increase the coverage on your existing policy, some companies will treat this as though you’re buying a whole new plan. That means your waiting periods may start over, and conditions that were previously covered by the policy will be considered pre-existing going forward.

Cosmetic or elective surgeries. Pet insurance generally won’t pay for procedures such as declawing, tail docking or ear cropping unless they’re deemed medically necessary.

Routine and wellness care. Most plans don’t cover the basics like annual vaccinations, spaying, neutering and teeth cleaning. However, you can often add this coverage for an extra cost.

Breeding. Expenses associated with breeding or pregnancy are another common exclusion, though you may be able to add a rider to cover these costs.

How does pet insurance work?

Most pet insurance plans allow you to bring your furry friend to any licensed vet for treatment, so you don’t need to worry about whether a given clinic is “in network.”

In most cases, you’ll pay the vet bill upfront, then submit your receipt to the insurance company for reimbursement. However, some pet insurers may be able to reimburse your vet directly so you don’t have to put out as much of your own money.

Below are a few factors that could affect how much of your vet bill your insurer will cover.

Payout limits

A few plans don’t cap how much they’ll pay for covered treatments, but most insurers have maximum payouts. Here’s where you need to read the policy language carefully. There may be a payout limit for the year, for your pet’s lifetime or for a type of incident or condition. Or there might be a combination of caps.

Deductibles

A deductible is the amount you pay out of pocket before the insurance company starts paying. Under many pet insurance plans, the deductible is applied annually. Once you’ve paid the deductible toward covered treatment, the plan starts reimbursing you. The deductible is reset when you renew the policy each year.

Under some other plans, the deductible is applied per incident. Once you pay the deductible for a particular injury or illness, the plan reimburses you up to the policy’s limits, even in subsequent plan years. This can save you money if your pet develops a chronic, lifelong condition. But if your pet develops a few different medical problems in one year, you have to pay the deductibles for each one.

Reimbursement levels

Pet insurance plans generally reimburse you a percentage of the treatment costs. You choose the reimbursement level when you buy the policy, such as 70%, 80% or 90%.

Read the details of how reimbursement works. Many plans reimburse you a percentage of the vet’s bill. Others reimburse you based on a benefit schedule they’ve established for each condition; if the vet charges more than the amount on the benefit schedule, you’re responsible for the difference.

What does pet insurance cost?

The average annual cost for a pet insurance policy covering accidents and illness was about $594 for dogs and $342 for cats in 2020, according to the North American Pet Health Insurance Association. The average annual premium for an accident-only plan was $218 for dogs and $134 for cats.

Prices for pet insurance are based on:

  • Your pet’s age and breed. The older your pet is, the more you’ll pay. Some breeds are more expensive to insure than others because they tend to have more health problems.

  • Your ZIP code. Local costs of veterinary care affect premiums.

  • Amount and type of coverage. The more the policy covers, the more you’ll pay.

  • Reimbursement level and deductible. The lower the reimbursement level and higher the deductible, the less you’ll pay for the plan.

  • Insurance company. Prices vary by company.

How to get pet insurance

Determine the type and amount of coverage you need, and then get pet insurance quotes from several companies. Online quotes are available from just about every major pet insurer, including options to customize your coverage.

Check that the policies have similar reimbursement levels, deductibles and annual payout limits to make sure you’re getting a fair comparison.

Before you buy, read the fine print to make sure you didn’t miss anything in the restrictions and exclusions. Many pet insurers have sample policies on their websites.

Keep in mind that you’re likely buying a policy your pet will have for life. With other types of insurance, shopping around each year for a new policy can save you money. But the older your pet gets, the more pre-existing conditions they’ll likely have — and none of them will be covered if you buy a new pet insurance plan. So do your best to pick a company and a level of coverage that you’ll be happy with long-term.

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