What Does Pet Insurance Cover?

Pet insurance is a lifesaver in more ways than one. If you have pet insurance, you likely won’t have to be one of the increasing numbers of pet owners who have to put their pets down due to lack of funds. With pet insurance, you can afford complex treatments and really give your pet the best chance at a full recovery and a healthy life, while also saving your pocketbook.

What You Will Learn

With pet insurance plans starting as low as $10 per month, you can achieve three levels of coverage with most insurers. They are: accident-only, accident plus illness and comprehensive. When looking at different pet insurance companies, realize that the naming convention may vary from provider to provider, but the general idea is the same. Note: just because a plan is ‘comprehensive’ doesn’t mean it covers routine wellness, so be sure to check.

If are lucky enough to have healthy pets that stay that way until they reach old age, then you may not see the need for pet insurance. But if you are like many pet owners whose pet has suffered from an illness like a torn ligament, cancer, a car accident or any number of other things, then pet insurance starts to look like a really good idea, and these pet owners say without reservation that they will not go without pet insurance again.

What is pet insurance?

With the exception of a few providers, pet insurance works a bit differently than its counterpart, human insurance. With our health insurance policies, you show your insurance card and the provider is able to verify benefits at or before your visit.

While some companies operate this way, most pet insurance providers work off reimbursement, so you are still responsible for the up-front cost, and the company will send you a check or deposit money into your account some time after the claim is filed.

And there is no Affordable Care Act for pets – they still get denied for pre-existing conditions. That’s why it is crucial that you enroll your pets early in their life. But it’s not too late if they are senior pets – there are many policies that will take pets over the age of 14 (but not all).

Why do you need pet coverage?

If your pet gets sick or is injured, they deserve the best care money can buy.

With all of the advances in veterinary care, there is a lot more that can be done for pets now than in the past, and you can get access to this care but not have to cover the entire cost if you have a pet plan.

Many pet owners take out pet insurance not only for peace of mind, but also so they can take advantage of the many treatment options that are now available, leaving them able to diagnose and treat conditions that may have gone unnoticed before, giving you many more years with your pet.

Veterinary medicine is advancing just like human medicine, and with better diagnostic capabilities and more options for care like chemotherapy and radiation, hip replacement and other things that previously would not have been thought of for animals, are now a reality.

With these advances, though, comes cost. In 2015, people spent almost $15 billion on veterinary care, and only a small fraction of those people had a pet insurance policy. Part of the issue is communication, and getting pet owners the facts and figures about life with and without pet insurance before they need it – because then it is usually too late.

What does pet insurance cover?

Depending on your plan, you can get pet insurance to cover most anything, barring the preexisting condition clause in your policy. Your best bet is to get pet insurance starting when your pet is very young, that way pre-existing conditions aren’t a factor.

Pet plans cover accidents and illnesses, depending on your plan. You can also add preventive or wellness care to your policy if it is not included.

If nothing else, make sure your pet insurance plan covers these:

  • Accidents and illnesses
  • Congenital and hereditary conditions
  • Cancer and chronic diseases

These are the things that can really get you in trouble financially as a pet owner, and a good pet insurance policy will provide you peace of mind in hard times if these base things are part of your coverage.

Chronic and ongoing conditions

Some pet insurance plans operate off of a per-incident deductible, while others operate off an annual deductible, and still others have a per-incident, per-policy year deductible. What this means is the cost you are responsible for paying before your insurance kicks in. Don’t wait until your pet is suffering from a chronic condition. Instead, do your research and if you have a breed that is prone to chronic conditions, then enroll your pet in a policy now, before it is too late to get them coverage.

Chronic conditions also include things like cancer and diabetes, which may or may not be hereditary. Either way, any condition where your pet needs continual care over a long period of time is considered a chronic condition. Keep in mind, too, that some deductibles work off a policy year, while others operate in a calendar year, meaning even if you just paid your deductible in October, you may need to pay it again in January. Check sample policy documents and read your own policy carefully to determine the terms around your deductible.

If you have a pet with a torn ACL, you may think it is too late to get the other knee covered. While it is true that some policies will not cover your pet’s knees once they have experienced an issue in one knee, other policies simply don’t have this exclusion or have a waiting period. While it is best to insure your pets before issues occur, all is not lost if your pet does have an initial knee injury you have to pay for out of pocket.

Hereditary and congenital conditions

It used to be the case that pet insurance policies wouldn’t cover things like hereditary or congenital conditions such as hip dysplasia or congenital deformities present at birth.

While most policies still will not cover conditions related to poor breeding practices, they will cover breed-specific conditions (unless they are pre-existing) due to legislation in California and sheer competition from the market that made policies more fair and competitive. Older dogs and cats no longer get dropped from policies and insurance companies need to have at least one plan that will cover these issues (usually their more expensive plan).

Some of the most common hereditary diseases in dogs are:

  • Hip dysplasia
  • Bladder stones
  • Epilepsy
  • Heart disease
  • Degenerative Myelopathy (spinal cord disease)
  • Brachycephalic Syndrome (breathing problems in ‘smushed face’ dogs)

In cats, you will find:

  • Feline lower urinary tract disease
  • Polycystic kidney disease
  • Heart disease
  • Manx syndrome

You definitely want pet insurance coverage for these items. Hip dysplasia can cost upwards of $7,000, and other issues like epilepsy or kidney disease. Epilepsy medication can cost $200 to $500 a year on the low end, and up to $5,000 a year on the high end. Without insurance, pet owners in this situation may choose euthanasia as the cost of treatment is simply too high.

Dental disease

While pet insurance doesn’t usually cover things like cleanings and extraction, it might cover other things like dental disease. By the age of three, most dogs and cats exhibit signs of periodontal disease. Apart from simply causing bad breath, periodontal disease can lead to tooth loss, and more seriously, damage of internal organs.

Many people aren’t aware if their pet insurance policy covers tooth care, and in most cases, they don’t cover cleanings, but they will cover accidental injury to teeth, including extractions and reconstructions.

Many insurers will cover up to a certain amount per year for teeth cleanings, such as $150 per year. Cleanings can run you about $400 in most cases, but every little bit helps when it comes to helping you take care of your dog or cat’s teeth. Make sure you see what the wellness and preventive offerings are for your chosen plan, and then check with your vet to see how much they charge. Any difference in cost you will be responsible for, so plan accordingly.

Alternative therapies

While things like physical therapy and stem cell treatments are now so common they are considered mainstream, there are still some supplements and some Eastern medicine tactics that are now used on dogs and cats and may be covered under your pet insurance policy.

Here are some of the covered alternative therapies:

Acupuncture

Stabilizes energy flow and brings the body back to balance, treats skin disorders, seizures, thyroid and heart conditions

Chiropractic

Helps with post-surgical healing and connecting the brain and spine for injuries to patellae, joints and tails in dogs and cats

Hydrotherapy

Swimming sessions in a heated pool, helps with arthritis, hip problems, fractures and reduces pain and swelling

Behavioral issues

From things as simple as behavioral training to more serious issues like excessive biting or chewing or even separation anxiety, you can find policies that will cover these. Some insurance carriers only cover the more serious behavioral concerns, but others cover even basic training so you can have a happier pet home. Consult your pet insurance policy to see which behavioral therapies are included.

Other things that may be covered:

If you have a comprehensive policy, you will find that many things are covered. There are all sorts of innovative coverage types included in today’s modern pet insurance policies that include things like lost pet promotion, where you get funds to help look for your pet, make signs and offer a reward, boarding coverage and even trip cancellation coverage if you are still required to pay some amount to your boarding facility in the event of an unexpected trip cancellation, you can expect to have some of that covered by your pet insurance policy.

What is not covered in your pet insurance policy?

We tried to keep the focus here on what is covered, but it is also important that you know what is not covered.

Pre-existing conditions

Anything that occurred prior to you getting covered (or happened during the waiting period, such as a torn ACL) is considered pre-existing. Therefore, any claim that you submit related to any of these issues will be denied.

Exam fees and routine care

Some (but not all) policies will include exam fees, but often that is a left-out part of a policy unless you get a wellness add-on. Since pet insurance is usually reserved for emergencies, you will need to check your plan to see if exam fees, routine vaccinations, fecal exams and other annual checkup items are covered.

End of life care

Everything from euthanasia (if ordered by a doctor) to cremation might be covered. Check with your plan policy documents and know what you can expect when the sad time comes that you have to deal with end-of-life arrangements.

Ending thoughts

We hope this gives you an overview of what pet insurance covers. As always, make sure you read the fine print on the policies, know your breed, comparison shop and do comprehensive research (hopefully on our site) before you buy.

Click here to subscribe