Pet insurance sounds simple until you read the 40-page policy. One company covers hip dysplasia, another excludes it forever if your dog ever limped as a puppy. This 2025 guide cuts through the marketing fluff and shows exactly what pet insurance covers, what it never covers, and which add-ons actually make sense.
The Three Main Types of Pet Insurance Plans
- Accident-Only Plans
Cheapest option ($10–$25/month). Covers broken bones, bite wounds, swallowed objects, car accidents, and toxic ingestions. Nothing else. Perfect for young, healthy pets if you only fear sudden trauma. - Accident & Illness Plans (the most popular)
Adds coverage for cancer, allergies, arthritis, infections, diabetes, Cushing’s disease, and most hereditary conditions — if symptoms start after the waiting period. 92% of policies sold in North America fall into this category. - Comprehensive Plans with Wellness/Routine Care
Takes accident & illness and adds vaccinations, dental cleanings, flea prevention, and spay/neuter. These riders almost always lose money, but some owners love the “one-and-done” budgeting.
Core Coverages: What Good Pet Insurance Pays For
Top-tier accident & illness plans in 2025 reimburse the following when conditions arise after enrollment:
- Emergency exams and hospitalization
- Diagnostic tests (blood work, X-rays, ultrasounds, MRIs, CT scans)
- Surgery and anesthesia
- Cancer treatment (chemotherapy, radiation, surgery)
- Prescription medications
- Hereditary and congenital conditions (hip dysplasia, heart defects, liver shunts)
- Chronic conditions (IBD, diabetes, hypothyroidism — for life once approved)
- Alternative therapies (acupuncture, hydrotherapy, chiropractic — if performed by a licensed vet)
- Euthanasia and cremation (if medically necessary)
Example: A Golden Retriever tears both cruciates at age 6. A solid policy pays 80–90% of $5,000–$7,000 per knee, plus rehab and pain meds — often $12,000+ total.
The Universal Exclusions — What No Policy Ever Covers
Every single pet insurance company excludes these items 100% of the time:
- Pre-existing conditions (anything your pet showed signs of before the policy started or during waiting periods)
- Cosmetic procedures (tail docking, ear cropping, dewclaw removal)
- Breeding, pregnancy, and whelping costs
- DNA/breeding testing
- Behavioral training (unless tied to a covered medical diagnosis and performed by a vet)
- Grooming and boarding
- Injuries from organized fighting or racing
The Gray-Zone Exclusions That Vary by Company
These conditions appear on some exclusion lists but not others. Always check the sample policy before buying:
| Condition | Covered By | Permanently Excluded By |
|---|---|---|
| Hip dysplasia | Trupanion, Embrace, Healthy Paws | Nationwide, Pets Best, ManyMeow |
| Cruciate ligament injuries | Most companies (with waiting period) | Some exclude if other knee ever injured |
| Dental illness | Embrace, Pets Best (up to limit) | Almost everyone else |
| IVDD (Dachshund back disease) | Trupanion, ASPCA | Figo, Nationwide |
| Luxating patella | Most (after orthopedic waiting period) | Some small breeds excluded |
| Curable vs incurable cancers | All cover both | Some older policies limit “curable” only |
Waiting Periods: When Coverage Actually Starts
- Accidents: 0–14 days (Trupanion = 0 days, most others = 3–14 days)
- Illness: 14 days standard
- Orthopedic conditions (cruciates, hip dysplasia): 14 days to 6 months (Healthy Paws now 15 days; Embrace 6 months unless vet waiver submitted)
Enroll puppies and kittens at 6–8 weeks to minimize future exclusion risk.
Wellness and Preventive Care Add-Ons — Worth It?
Almost every insurer offers a wellness rider ($10–$35 extra per month). Typical 2025 payout schedules:
| Tier | Monthly Add-on | Annual Benefit Limit | Common Reimbursements |
|---|---|---|---|
| Basic | $10–$15 | $250 | Vaccines, fecal, heartworm test |
| Plus | $18–$25 | $450 | + Dental cleaning, blood work |
| Prime | $30–$45 | $650 | + Spay/neuter, flea/tick prevention |
Reality check: Owners pay $120–$540/year for these riders and receive $250–$650 back. Mathematically, you lose money 80–90% of the time. Only buy wellness if you value simplicity over savings.
Exam Fees and the “Hidden” Deductible Killer
Some companies (Nationwide, Figo, AKC) cover exam fees. Others (Healthy Paws, Trupanion before 2024) exclude them completely. A $150 emergency exam suddenly becomes 100% out-of-pocket on the wrong policy — and that happens on every claim.
Deductible Types That Change Everything
- Annual deductible (most common): Pay once per year, then 80–90% reimbursement kicks in.
- Per-condition deductible: Pay $250–$1,000 every time a new condition appears — even years later. Avoid these unless the premium is dramatically lower.
- Lifetime deductible: Trupanion’s model — pay $0–$1,000 once in the pet’s entire life. Huge long-term winner for chronic conditions.
Prescription Food and Supplements
Embrace and Pets Best cover Hill’s and Royal Canin prescription diets with no annual limit if a vet documents medical necessity. Most other companies refuse or cap at $200–$300/year.
End-of-Life Coverage
Good policies pay for euthanasia when a veterinarian deems it medically necessary. They also reimburse cremation or burial up to $300–$500. Read the fine print — some require terminal illness diagnosis; others cover quality-of-life decisions.
How to Choose the Right Coverage in 2025
- Start before 12 weeks old if possible — locks in lowest rates and zero pre-existing conditions.
- Prioritize unlimited annual payouts (or at least $20,000+).
- Pick 80% or 90% reimbursement and $250–$500 annual deductible.
- Confirm cruciate ligaments, hip dysplasia, and cancer have no special exclusions for your breed.
- Verify exam fees and prescription medications are included.
The Bottom Line
Pet insurance covers accidents, illnesses, hereditary conditions, and chronic disease — but only when symptoms begin after the policy starts. Pre-existing conditions remain the #1 reason claims get denied. Buy early, choose a reputable accident & illness plan with unlimited or high limits, skip the wellness rider unless budgeting trumps math, and read the exclusions page like your wallet depends on it — because it does.