'I’m a Vet, and Here’s How Pet Insurance Actually Works, & Why It’s a Must'

Zoe Weiner
·8 min read
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As the proud mom of a very spoiled 3-year-old toy poodle (fellow pandemic puppy people—I see you), I know all too well how frequently those furry friends of ours can get sick. What starts with a pair of puppy eyes begging for a bite of the “cheese tax” can end with a big ol’ mess on the rug; a trip to puppy daycare can leave your snuggle buddy with a cough they just can’t shake; and an innocent jaunt outside can end with the type of itching and scratching that has you praying there aren’t any fleas in the woods behind your house (surprise!).

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Most of us are willing to do anything to keep our itty-bitty besties happy and healthy. But that “anything” can often run you a serious chunk of change at the vet’s office, which is why any veterinarian will tell you that pet insurance is an absolute must.


“As a veterinarian, I believe that there are countless benefits to pet insurance,” says Xander Simunek, DVM, a veterinarian who practices in Greenwich, CT. “From a financial perspective, having a pet insured can sometimes be the difference between life and death. Veterinary care is expensive, but even more at the emergency or specialty hospital when you least expect it.”

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Convinced to make the investment (I know I am.)? Here’s everything you need to know.


How does pet insurance work? A vet explains


Depending on the plan you choose, it covers veterinary expenses related to accidents, emergencies, or preventative care for your pet.


“Pet insurance allows owners to make informed healthcare decisions that are in the best interest of their pet(s) [and get help with] the financial burden of that decision,” says Dr. Simunek. “Pet insurance can also provide a great sense of peace, especially in those stressful moments. Whether you’re contemplating a surgical procedure or discussing the treatment options for a newly diagnosed chronic condition, the comfort in knowing there will be financial help is priceless.”


Once you enroll in a plan, you’ll pay a premium that depends on factors like your pet’s age, breed, location, and the type of coverage you want. Just like other insurance, there is often an out-of-pocket deductible that you’ll be responsible for before the plan kicks in with reimbursements (but, again, this will depend on the plan you opt into).


“Pet insurance plans vary greatly from company to company—like indemnity insurance (i.e., auto and homeowners’ insurance), there is typically a range of monthly premiums and annual deductibles that can be initially selected by the pet owner when selecting pet insurance,” says Dr. Simunek. “Some veterinarians will accept payment directly from the insurance company, while others will expect payment from the owner at the time of service, providing an invoice to submit to the insurance company for reimbursement.”


How do pet insurance deductibles work?


Like with other types of insurance, pet insurance plans typically come with a deductible—which is an amount of money you’ll have to pay out of pocket before your insurance kicks in to cover the rest. Most plans come along with an annual deductible (typically, the higher the premium you pay for the plan per month, the lower your deductible will be), and some come along with per-incident or per-condition deductibles (meaning that if your pet has a new incident or condition, some plans may have different deductibles that go along with them).


What does pet insurance usually cover?


“Nothing is ‘typical’ when it comes to pet insurance—coverage varies widely and ultimately depends on the individual plan chosen,” says Dr. Simunek. “Generally, accidents, injuries, and illnesses are often covered. Routine pet care plans that cover vaccinations, annual blood work, spays/neuters, etc. are usually optional add-ons that should be considered.”


To give you a bit of a clearer picture, let’s break down the offerings from Lemonade, a popular pet insurance brand on the market. For Luna—a 3-year-old toy poodle who lives in New York City—the company’s plans look like this:


$60.82/month (Base Plan): Covers diagnostics (blood tests, urinalysis, and MRIs), surgeries (outpatient, specialty, and emergency care, hospitalization, and surgery), and medications (prescriptions and injections) for eligible accidents and/or illnesses.


$11.97/month add-on: Covers vet visit fees (any fees charged by your vet for eligible accident- or illness-related visits).


$11.66/month add-on: Covers eligible dental illness (treatments for things such as gum disease and tooth extractions up to $1,000 a year).


$3.14/month add-on: Covers behavioral conditions (diagnoses, therapy sessions, and meds for new behavioral conditions up to $1,000 a year).


$3.89/month add-on: Covers physical therapy (treatments like acupuncture, chiropractic care, and more related to eligible accidents and illnesses).


$3.38/month add-on: Covers eligible end-of-life and remembrance (euthanasia, cremation, and a special memorial item with no deductible up to $500 a year)


$17.59/month OR $26.71/month: Covers eligible preventative care (the more affordable option includes a wellness exam, three vaccines, a parasite test, a heartworm test, and a blood test; the pricier option includes all of that plus a routine dental cleaning and flea/tick/heartworm meds)


If I were to opt in for all of the above (including the pricier preventative care plan), the total would be $120.83 a month with an annual deductible of $250. From there, Lemonade will pay 80 percent of eligible accident and illness claims up to $20,000 a year.


Of course, this is only one example of what coverage can look like—there are plenty of plans out there to choose from (from Lemonade or other providers) that range in cost and coverage (for example, Luna’s coverage would have been cheaper had we signed up when she was a pup), so it’s all about doing the research to find the best one for you and your pet.

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What does pet insurance not cover?


Again, it depends on the plan you choose. “There may be clauses regarding specific ailments, depending on the plan you have chosen and the insurance company,” says Dr. Simunek. “Nevertheless, ‘pre-existing health conditions’—or those existing prior to the purchase of the insurance plan—are rarely covered. This tends to be the biggest area where people have difficulty and/or find confusion with claims.”


To use the real-life example of Lemonade again, spaying and neutering, dental conditions (unless you opt in for the dental illness add-on), and anything that happens during the “waiting period” before your plan kicks in ( 2 days for injury, 14 days for illness, and 6 months for cruciate ligament events) aren’t covered. Additionally, pre-existing conditions—which Lemonade characterizes as “any kind of illness or health issue your pet developed before your waiting period is over” or any current illness for which your pet is already experiencing symptoms—aren’t covered. However, if your pet shows signs of a condition after the waiting period is over, they will likely be covered.


Do you really need pet insurance?


From a vet’s perspective (which, really, is the only perspective that matters here), it’s a definitive Y-E-S. “Nobody anticipates a serious pet emergency or chronic illness, and not everyone is financially able to afford the best care for their pet, especially in those critical times of need,” says Dr. Simunek. “Pet insurance is highly recommended for all pets at any stage of life. Most insurance policies can be tailored to an individual pet’s needs, making every pet a good candidate for insurance. “


FAQs:


When should I get pet insurance?


“Pet insurance should be obtained ASAP—ideally, the first day you take home your pet,” says Dr. Simunek. “Some pet insurance providers have incentives based on when you purchase your policy, which owners should be familiar with before deciding on a policy. Pet owners should also pay particularly close attention to the “waiting period” between when the plan is initiated and when it begins to cover certain ailments.”


Can my pet be denied pet insurance?


There are certain restrictions on pet insurance that vary from company to company and plan to plan. Generally speaking, a pet may be denied coverage based on their age (more on that below), pre-existing conditions, breed (due to breed-specific health concerns), behavioral concerns (namely, aggression), and vaccination status.


Do vets require insurance?


Nope!


Does pet insurance cover meds?


It depends on the plan you choose. Basic plans will typically cover prescription medications, but many policies have coverage limits or deductibles.


What if my pet is older? Will they still be covered?


Yes, but there are a few things to keep in mind. Certain insurance providers have age limits on pets they will provide new coverage for (in the case of Lemonade, pets above a certain age won’t be eligible to sign up for a new plan. The exact age limit depends on the breed.


This advertisement is financially sponsored by Lemonade Insurance Agency, LLC.  This post should not be relied upon instead of professional legal, insurance or financial advice. Its content does not alter the terms, conditions, exclusions, or limitations of policies issued by Lemonade, which differ according to your state of residence. Over time, legal conditions or policy details may change and statements may no longer be accurate. Any hypothetical examples used are purely expositional. Hypothetical examples do not alter or bind Lemonade to any application of your insurance policy to the particular facts and circumstances of any actual claim.

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