What Does Accident and Illness Pet Insurance Cover?

What does accident and illness pet insurance cover?

Accident and illness pet insurance covers vet bills for new injuries and new illnesses that start after your coverage begins. NerdWallet describes it as the most common type of policy, typically reimbursing prescription medicine, surgery, diagnostic tests, hospitalization and emergency care.

ASPCA’s version is a useful example of a broad plan. It lists:

• Accidents: bite wounds, cuts, broken bones, swallowed objects and toxic ingestions.
• Illnesses: cancer, arthritis, hypothyroidism, ear infections, digestive problems and urinary tract infections.
• Hereditary and congenital conditions: heart disease, intervertebral disc disease, eye disorders and hip dysplasia.
• Chronic conditions: ongoing problems like diabetes and cancer, covered across policy years.
• Diagnostics and treatment: X-rays, MRIs, ultrasounds, blood work, sutures, medication, hospital stays and surgery.

NerdWallet adds that many plans also cover acupuncture, physical therapy, behavioral therapy and end-of-life costs, though the list varies by insurer. A chronic condition, in the NAIC model law’s words, is one that can be treated or managed, but not cured.

What is usually not covered?

Four things are excluded by almost every accident-and-illness policy: pre-existing conditions, routine care, cosmetic procedures and breeding costs.

Usually excluded	Varies by insurer
Pre-existing conditions	Exam fees
Vaccines, checkups, routine dental cleaning	Dental illness
Ear cropping, tail docking, declawing	Prescription diets
Breeding and pregnancy	Behavioral therapy
	Hereditary and congenital conditions

A pre-existing condition is one your pet showed signs of before coverage started or during a waiting period. Some insurers will later cover a curable one, such as a past ear infection. Our pre-existing conditions guide explains the rules.

A wellness add-on is an optional extra that pays set amounts toward routine care like vaccines and checkups. The exam fee is what the vet charges just to see your pet, before any tests or treatment. Whether it is covered can change your payout on every visit, so check this line before you compare prices.

How much does accident and illness pet insurance cost?

Accident and illness cover averaged $836 a year for dogs and $435 a year for cats in the US in 2025, according to NAPHIA, the pet insurance trade group. NerdWallet’s 2026 figures match.

Plan type	Dogs	Cats
Accident only	$16 a month ($190 a year)	$9 a month ($112 a year)
Accident and illness	$70 a month ($836 a year)	$36 a month ($435 a year)
Accident, illness and wellness	$118 a month ($1,414 a year)	$72 a month ($859 a year)

Your price depends on breed, age, location and three choices you make. The deductible is what you pay each policy year before the insurer starts paying. The reimbursement rate is the share of each covered bill the insurer pays back, commonly 70%, 80% or 90%. The annual limit is the most the insurer will pay in a policy year. A higher deductible or lower reimbursement rate lowers the premium. Our deductible guide shows how to pick one, and our dog insurance cost guide breaks down prices further.

What does an illness claim look like?

An illness like diabetes shows why the illness half of the policy matters: the costs keep coming. The example bill on this page covers the first three months for a large dog, totaling $900.

Spot puts the first visit with blood work and urinalysis at $225 to $500, and insulin at $80 to $150 a month for larger dogs. MetLife lists general blood work at $150 to $370, and insulin at $30 to $150 a month.

With a $250 deductible and 80% reimbursement, the plan would pay $520 of that $900, and you would pay $380. After the deductible is met, the insurer keeps paying 80% of each month’s insulin for the rest of the policy year.

On an accident-only plan, the insurer would pay nothing for this illness. That is the core reason most owners choose accident-and-illness cover. Our accident-only guide compares the two plan types in detail.

Hereditary and chronic conditions: where plans differ

Hereditary and chronic conditions are where accident-and-illness plans differ most, so check them first. An NAIC guide for state regulators notes that some policies exclude congenital and hereditary conditions such as hip dysplasia, heart defects, cataracts and diabetes.

Other insurers build them in. ASPCA includes hereditary conditions in its base plan. Lemonade’s base plan covers hereditary conditions such as hip dysplasia, plus chronic conditions, infections and infestations. For breeds with known inherited risks, like the German shepherd or the bulldog, this clause can matter more than the premium.

Chronic conditions also raise a timing question. A chronic illness that starts after your waiting period stays eligible across policy years on plans like ASPCA’s. One that started before you enrolled is pre-existing and stays excluded, even if you switch insurers later.

Does it cover emergency visits and specialists?

Yes. Emergency and specialist care for a covered accident or illness is part of what these plans pay for, after your deductible and reimbursement rate are applied. NerdWallet lists emergency care, hospitalization and diagnostic tests among the standard benefits.

That matters because emergency care is where the largest single bills tend to land. MetLife puts emergency surgery at $1,800 to $5,000 for dogs and $1,500 to $3,000 for cats. It lists overnight hospitalization at $800 to $1,500 per night and an MRI at $1,500 to $2,500 or more.

Two limits still apply. The care must be for a condition that is not pre-existing, and the total paid in a policy year cannot exceed your annual limit. If you choose a low annual limit to save on premiums, one emergency surgery plus a few nights in hospital could use most of it. Our emergency coverage guide walks through common scenarios.

How long before illness coverage starts?

Illness coverage starts after a waiting period, the stretch after you buy a policy before certain claims are paid. For illnesses this is typically 14 to 30 days.

Insurer	Illness waiting period	Source
ASPCA	14 days	NerdWallet
Embrace	14 days	Insurer site
Healthy Paws	15 days in most states	Insurer site
Lemonade	14 days	Insurer site
Pets Best	14 days in most states	Forbes Advisor
Trupanion	30 days	Insurer site

Orthopedic problems such as cruciate ligament tears and hip dysplasia often have longer waits. Our waiting periods guide compares those and the state laws that cap them.

What should you check before you buy?

Before buying, check the parts of the policy that change what you get back on a real claim.

1. Exam fees. Are they in the base plan or an add-on?
2. Hereditary and chronic conditions. Are they covered, and for life?
3. Dental illness. NerdWallet says dental coverage varies widely between insurers. See our dental coverage guide.
4. Orthopedic waiting period. Months-long waits matter for large, active dogs.
5. How you get paid. Most plans reimburse you after you pay the vet. Lemonade, for example, pays your bank account, not the clinic. A few insurers can pay the vet directly; our guide on insurers that pay the vet directly explains how.

Bottom line

Accident and illness pet insurance is the standard pet policy, covering new injuries and new illnesses, including the tests, surgery and medication behind them. It averaged $836 a year for dogs and $435 for cats in 2025. Pre-existing conditions, routine care and cosmetic procedures are excluded everywhere, while exam fees, dental illness and hereditary conditions vary. Compare those clauses, not just the price, before you choose.