When Kate Castle’s Labrador Retriever Dexter was 8 weeks old, she and her partner signed up for a pet insurance policy.
Unfortunately, at 11 weeks, their pup fell ill and the couple ended up spending over $3,000 in medical bills. It turned out that Dexter suffered from a congenital disorder with his kidneys, and wasn’t going to make it.
Castle was shocked to discover that none of the medical costs would be covered, other than the $130 for the cremation—which took a mountain of paperwork and well over a month to get reimbursement for.
After recovering from the grief of losing their first dog, they decided to welcome another dog into their family.
After their experiences they would be far more attentive to the fine print of their pet insurance policy.
“This time around I decided to do a ton of research and read in depth what each company actually covered,” says Castle, a marketing partner at Flybridge Capital who lives in Somerville, Massachusetts.
While Castle learned the hard way about pet insurance coverage, you don’t have to. Pinpointing exactly what pet insurance plans cover can feel like a Herculean task for a litany of reasons.
We’ll go over the main things to check when comparing policies, and factors to look out for.
What does pet insurance cover exactly?
Typically, pet insurance can foot the vet bill if your dog or cat becomes sick or gets into an accident. Pet insurance is generally for dogs and cats. However, some insurance companies offer what’s called “exotic pet insurance,” and overs coverage for your gerbil, cockatiel, or frog.
That being said, there are a lot of things it may not cover. Unlike health insurance for humans, pet insurance doesn’t normally cover routine care, such as checkups and rabies shots.
While that’s the gist of it, there are different types of plans you can opt into it.
To help you get the best sense of what pet insurance covers, here are five key things to look closely at in your policy.
1. What type of plan do you have?
The four plan types of pet insurance plans are:
- Accident-Only Plans. Covers incidents and injuries such as ingestion of foreign objects, poisoning, if your pet was hit by a car, or ligament tears.
- Accident and Illness Plans. This is the most common type of plan. It covers accidents plus illnesses such as digestive issues, allergies, cancer, and infections.
- Insurance With Embedded Wellness. This comprehensive plan covers accidents and illness, and may cover heartworm prevention, vaccinations, cremation and burial, dietary consultations, flea and tick medication, and dental care.
- Endorsements. Also known as riders, these include cancer or wellness add-ons. Wellness plans typically only purchased as an add-on. However, some carriers do offer it as strictly as an add-on.
Among the four types of pet insurance, 98 percent of insured pets are covered by either accident or illness insurance, or insurance with the wellness add-on according to the NAPHIA. The remaining 2 percent is covered by accident-only coverage.
2. How is the coverage tiered?
Now here’s where it gets more tricky: There are no standard tiers for coverage among pet insurance companies.
When it comes to health insurance for humans, insurance is categorized as “bronze,” “silver,” “gold,” and “platinum,” with pretty much the same deductibles, and co-payments across the board.
But with pet insurance, each company has different ways of packaging their coverage. So the “basic” version for pet insurance carrier X could have different deductibles, premiums, co-pays and so forth than carrier Y.
It can feel like you’re comparing apples to oranges.
Confusing? Terribly so.
3. Do any exclusions apply to your pet?
When shopping, you’ll need to carefully review the different plans to see what is and isn’t covered.
“Look for a simple breakout of what is and is not covered under policies,” says Castle. “Most policies have what is not covered buried in a ton of legal language and are not up front about this.”
To make extra sure that there aren’t any major surprises should you need to file a claim, you’ll want to make note of the different exclusions, restrictions, and requirements.
Most pets need to be at least anywhere between 6 and 10 weeks to hop on a plan. (The age requirements are slightly different for dogs and cats.)
Many pet insurance companies have an age cap on illness and accident plans (it’s typically about 14 or so, but can vary.) So if you are trying to insure an elderly pet, accident-only insurance may be the only option.
Let’s say your pet has a congenital disorder or hereditary condition that it has been seen by a vet for before you hop on a policy.
If that’s the case, unfortunately most pet insurance companies won’t cover any medical expenses for that particular illness’ treatment.
However, some companies may cover a pre-existing condition if it has been cured. Or your pet has has shown no symptoms in the last, say, six months or year.
4. Will breed-specific conditions increase your costs?
It is very likely, even if it. seems unfair. Sadly, because you’re the pet parent of a breed that is known to have what’s known as breed-specific conditions, this means they are at risk for certain genetic disorders, and in turn they are seen as higher risk to insure.
And because purebred animals have a higher chance of passing on these genetic defects, they may be more costly to insure.
5. Does pet insurance cover pet liability?
Usually, it does not. Pet liability is different than pet insurance, which covers your pet’s health and wellness.
Instead check to see if your home insurance covers things like dog bites and the costs associated with them. If not, you may need to purchase a separate type of insurance.
Doing your homework pays off
Because pet insurance can be quite confusing, do as much research as you can upfront. Read up on reviews on trusted, reputable sites (i.e., TrustPilot, BBB, and Consumer Reports).
“Ask friends or neighbors who have dogs,” suggests Castle. “And independent vets who do not have affiliate relationships with insurance companies are also a great resource. They know which insurance companies challenge payments and are good to deal with an ones that are not.”
A lot of information can be found on the insurance company’s website. Check out the FAQ section, or review a sample policy. If you have questions, reach out to a customer rep and get as much information as possible before signing up.
How much will pet insurance cost each month?
Per the NAPHIA, the average monthly premium for a dog in 2017 in the U.S. with accident and illness insurance was $44.67, and $15.84 for an accident-only plan.
Average monthly premiums for cats in 2017 were a bit lower: $27.93 for accident and illness plans, and $12.72 for accident-only coverage.
And like health insurance for humans, you have deductibles, monthly premiums, and co-payments.
Some plans have yearly deductibles with annual limits, and will cover treatments up to a certain amount. You’ll need to pay your yearly deductible before your insurance sets in.
Other plans a schedule of benefits, which have a cap per treatment or procedure within a given time period, so you’ll need to read the fine print.
And the lower your monthly premium, the higher your deductible and co-pays tend to be.
So let’s say you take your kitten in for ringworm treatment, and the bill was $100. If you’ve paid your deductible for the year, and your reimbursement level is 80 percent, you’ll get $80 back from the insurance company.
Here’s another tricky part: Exam and consultation fees for a certain condition may not be covered, even if it’s an illness or injury. Once again, you’ll need to read the fine print.
Is Pet Insurance Worth It?
So after paying your monthly premiums, how much reimbursement can you expect? Depending on your plan, reimbursement amounts can be anywhere from 70 to 90 percent of the total claim. The average amount paid for claims under accident and illness plans was $278 in the U.S.
The funny thing is that while it’s least expensive to hop onto a plan when your pet is young and healthy, you’ll most likely need it when your pet gets older.
And premiums generally increase every year for several reasons: as your pet ages, the chances of them becoming ill go up; and veterinary costs as a whole gets more expensive.
As you may expect, there’s really no cut-and-dried answer. In Castle’s case, she found that pet insurance was good to have for large, catastrophic events. But getting coverage for the small stuff, such as annual exams? Not so much.
And while some strongly vouch for pet insurance, because of all the exclusions, waiting periods, and restrictions, some think it be better to create a pet health savings fund on your own, and cover medical bills entirely out of pocket.
Whatever your situation is, be sure to comb through the fine print so you can make heads or tails of what the policies cover. Otherwise, pet insurance may not be the best fit for your needs and situation.