What Does Pet Insurance Cover

What Does Pet Insurance Cover? How it works in 2022

Keeping a pet is not only fun but is also not cheap. Just like having kids, a lot of pet owners grow a profound affinity for the pets and refuse to have them face any form of lack of harm.

This brings more responsibility in catering to the pet’s needs, including food, treats, toys, occasional vet visits, and puppy training. Whilst calculating all these, one might not see the need for pet insurance as healthcare costs rise across the board, pet healthcare is no exception. 

Considering what pet insurance covers in costs and risks, it has proven to be worth it. This guide explains what pet insurance is, what it covers and what to expect.

What Is Pet Insurance?

Pet insurance is a form of health insurance that enables you to make provisions for your pet. It covers (reimburses) the costs of treating unexpected injuries and illnesses, so you don’t have to worry as much about expensive vet bills. 

Pet insurance is a lot like car insurance. It’s designed to protect you from financial risk by reimbursing you for planned and unplanned vet costs. Unlike human health insurance, you can use your benefits at any vet or animal hospital.

How Does Pet Insurance Work?

On a month-to-month basis, pet insurance works most like renter’s insurance. You pay a monthly premium to your insurer for coverage. 

Your policy will outline which conditions/expenses are covered, your reimbursement rate, your deductible, and the maximum payout (or annual limit).

Most pet health insurance plans will reimburse you, the policyholder, rather than pay the vet directly. 

This means you don’t have to worry about finding an “in-network” vet and can benefit from your coverage at any licensed vet clinic or animal hospital around you.

Though sometimes, if it is important to you, some providers do offer the option to pay the vet directly (though you will have to find in-network vets to use the direct-pay option).

Getting Payment from any Pet Insurance Company:

  • Pay the vet bill during your visit.
  • Submit a claim to your insurance company.
  • Get reimbursed for 70% to 100% of covered expenses (after your deductible is met)

Insurance companies (also known as “providers” or “carriers”) may need paperwork or a medical history review from your veterinarian to process your claim, so be sure to save all receipts and documentation you receive from your vet appointment.

On average, policyholders get reimbursed within 5 to 9 days after submitting a claim.

Also, some providers will pre-approve you for an upcoming procedure and offer to pay the veterinarian directly, alleviating the initial financial burden.

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 a type of incident or condition. Or there might be a combination of caps.

Deductibles

A deductible is an amount you pay out of pocket before the insurance company pays. Under many pet insurance plans, the deductible is applied annually. 

Once you’ve paid the deductible toward covered treatment, the plan reimburses 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.

Who’s Eligible for Pet Insurance?

Most pet insurance companies insure only dogs and cats. The ASPCA insures horses too, while Nationwide and Bivvy sell 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.

Why Is Pet Insurance So Important?

Getting pet insurance is both an economic and an emotional decision that should be based on the type of pet you have, your appetite for risk, and your financial situation. 

Pet insurance can also help bridge the gap between your pet’s medical bills today and an emergency fund, which may take time to build.

Equally, pet insurance allows pet owners to make medical decisions based on the health and welfare of their pet rather than what they can afford,” says Dr. Gary Richter, a veterinary health expert. “No one should have to make life or death decisions based on cost.”

What Does Pet Insurance Cover?

Depending on your insurance plan, your policy may not cover every condition/expense your pet has, and it is important to find a plan that covers your pet’s breed-specific health risks. 

As it is for humans, there are different levels of health coverage and deductibles that you can customize to fit your pet’s needs. 

Pet Insurance Can Cover:

  • Unexpected injuries/accidents (like foreign object ingestion, broken bones, and more)
  • Unexpected illnesses (like cancer, glaucoma, hip dysplasia, parvovirus, and more)
  • Surgery (like cruciate ligament tears, cataracts, and more)
  • Medication
  • Tests/diagnostics (like x-rays, blood tests, MRIs, and more)
  • Emergency exam fees

However, the details will be determined by the type of coverage.

Types of Pet Insurance Coverage:

There are 3 major types of coverage a pet owner can choose from: 

  • Accident and illness; Accident and illness policies provide coverage for both accidents and unexpected illnesses. It is the most common, as it represents about 98% of plans issued by the pet insurance industry. This type of plan won’t cover preventive care or pre-existing conditions, but you can expect reimbursement for almost everything else. It covers injuries in addition to most illnesses.
  • Accident-only; accident-only policies will only provide reimbursement for emergency care related to accidents, like if a car hurts your pet or injures themselves by falling down the stairs. This type of coverage does not cover illnesses or breed-specific issues, it only covers injuries.  
  • Wellness Plan; Wellness plans typically cover your pet’s preventative care costs, such as annual checkups and routine vaccinations.

A Wellness Plan is often not considered pet insurance. They help with costs around routine care, preventative care, checkups, and yearly vaccines, but not much else. These are usually sold as add-on features to other health insurance plans. This type of plan does not cover accidents, common injuries, or emergency treatments for illnesses.

  • You can purchase an accident-illness plan with a wellness add-on. This is the most expensive type of plan on the market, but it provides the most comprehensive level of coverage. The only health issues that aren’t covered pre-existing conditions.

What Pet Insurance Does ‘Not’ Cover

There are a few things your pet insurance may not cover, such as;

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 before your coverage began. 

Any pet insurance plan rarely covers these. 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 pre-existing in the future.

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.

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 wait 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.

Waht Does Pet Insurance Cost?

How much you pay for pet insurance varies greatly. Monthly premiums can range from as low as $10 to higher than $100, though most pet owners can expect to pay between $30 and $50 per month for a plan with decent coverage.

Your pet’s age, species, and breed, as well as where you live, reimbursement level, the insurance company, and the coverage you choose, all factor into your insurance rates.

The average cost of pet insurance is higher for dogs — 74% more expensive than cats for accident and illness policies. Older animals and larger animals also face higher pet insurance rates, as these groups tend to have the most health issues.

monthly, pet insurance plan ranges from about $24 to $86 for dogs and $9 to $30 for cats, based on an analysis of quotes from the largest pet insurance companies.

FAQs About Pet Insurance Coverage

What are the alternatives to pet insurance?

If you don’t want to pay for pet insurance, start an emergency fund for your pet instead. If you ever have trouble affording your pet’s medical bills, the Humane Society has a list of pet financial aid and discounted veterinary care-related organizations that can help you. Additionally, many vets are willing to work with you to figure out a payment plan.

Does pet insurance cover medication?

Regarding Medication or the drugs prescribed, most pet insurance plans cover at least some of them. This includes medication associated with a covered accident or illness. Whereas most preventative medications, such as flea and tick treatment, are only covered if you have a wellness add-on to your plan.

Does pet insurance cover surgeries?

Pet insurance plans sometimes cover medically necessary surgeries, including emergency surgeries and some preventative procedures. On the contrary, optional or elective surgeries are usually not covered, and some surgeries may be excluded if they’re related to a pre-existing condition.

When is it too late to get pet insurance?

Although we recommend getting your pets insured as early as possible when they are young, it is never categorically too late to ensure your beloved animal if it has gotten older. There as several reasons to consider insuring an elderly pet.

References

  • time.com – I’ve Spent Over $2,000 on My Dog, But I Still Don’t Have Pet Insurance. Here’s Why
  • nerdwallet.com – What Is Pet Insurance, and What Does It Cover?
  • valuepenguin.com – Average Cost of Pet Insurance: 2022 Facts and Figures
  • pawlicy.com – What Is Pet Insurance, How Does It Work, & What Is Covered? A Pet Parent’s Guide

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