Pet insurance is similar to human health insurance in some basic ways: you pay a monthly premium, and your vet bills are at least partly reimbursed, generally after you have paid out a certain amount on your own (the deductible). However, what it does and does not cover may be rather different from a human health plan, which can be a bit confusing. We explore some of the finer points of what pet insurance covers in the sections below.
This article is adapted from our in-depth report, The Best Pet Insurance Companies for 2021: A Pet Parent’s Guide.
What does pet insurance cover?
The answer to “what does pet insurance cover” depends in large part on what insurance plan you decide to buy. A typical basic dog or cat insurance plan covers treatment when your pet is injured or ill, and does not cover routine care. However, some plans offer add-on coverage, which can include non-emergency care, prescriptions and medication, and/or other services. Some companies also offer plans that cover some or all routine care.
If you have one of the more basic plans that does not cover routine and preventative care, it’s important to understand what that means. You will need to pay the full bill for what’s also often called “wellness care,” such as annual exams and vaccinations. You will be only reimbursed for care when your pet has an illness or injury that needs to be treated. So you’ll need to pay the full cost of your yearly exam, where your vet looks into your pet’s ears to make sure they’re OK. But if she finds that your pet has an ear infection, the treatment will be covered.
Of course preventative care like annual exams and shots are important to keep your pet healthy. But they’re a predictable expense that you can budget for. The idea of most pet insurance is to cover the unexpected, where costs can quickly balloon. Again, though, if you want it, you can purchase plans that will cover all or some non-emergency care, although it will be more expensive.
One important and often confusing case is that a basic plan will cover surgery to treat an illness or injury, but it generally will not cover spaying and neutering. Yes, that’s surgery—but it’s not done because of an accident or sickness, so in most cases you will not be reimbursed.
Does pet insurance cover dental?
Dental care is generally treated the same way as other care: yes for illness/injury, no for “wellness”/preventative care. So a basic plan will generally not cover routine dental cleanings, but it will likely cover, say, treatment of a dental infection or extraction of a broken tooth. Again, dental cleanings are important preventative care, but they are a predictable expense you can budget for. It is probably more important to make sure your plan covers all possible unexpected dental problems.
As with other preventative health care, some companies offer full dental care coverage at an additional cost.
Does pet insurance cover prescriptions or medication?
Most pet insurance plans cover prescriptions to treat an illness or injury. As you might expect at this point, however, a basic plan will not cover prescriptions or medication that count as wellness or preventative care. This would include prescription food, supplements to support or maintain health, or flea and tick preventatives. Some companies offer additional coverage or more comprehensive plans that cover all or both of these, but you will need to read the terms carefully to determine if this is the case.
Does pet insurance cover pre-existing conditions?
A pre-existing condition is one that showed symptoms or was diagnosed before you purchased your policy. These are almost never covered by pet insurance. This can be a source of frustration and misunderstanding for pet owners. Most companies we surveyed report that one of their most common reasons for denying a claim is because it was a pre-existing condition. While some of these cases likely involve customers who didn’t understand what was and was not covered by their plan, disputes do arise about what counts as “pre-existing.”
One way to avoid this problem is to purchase your policy as early in your pet’s life as possible. It’s less expensive to get a policy when your pet is young, and if you’ve bought the plan before problems arise, they will be covered.
A related issue is whether breed-specific hereditary or congenital problems are covered, for example, issues like airway surgery for a Pug or French Bulldog. Some plans cover these and some do not, so if you have a dog or cat breed that is prone to specific health issues, you should choose a plan carefully (you can see what we found out about this here).
However, even plans that cover these conditions do not cover them if they are pre-existing. This can be a bit confusing because a congenital condition is one that is by definition present at birth, and you can’t buy a plan for an animal that hasn’t been born yet, so how is a congenital condition ever not pre-existing? What matters is whether there has been evidence of the problem, or an actual diagnosis, before the plan was purchased. If so, it’s pre-existing and will not be covered.
For more about pet health insurance, see our article, The Best Pet Insurance Companies for 2021: A Pet Parent’s Guide.