What Does Pet Insurance Cover? The Full Covered and Excluded List

What does pet insurance cover?

Pet insurance covers the cost of treating new accidents and illnesses: the diagnostic tests, surgery, hospital stays, emergency care and prescription medicine your vet uses. NerdWallet lists hospitalization, medicine, diagnostic tests and surgery as the core of a standard policy.

What you get depends on which of three plan types you buy, and on a handful of clauses that vary between insurers. This page maps all of it. Each section links to a detailed guide.

Category	Accident only	Accident and illness	Wellness add-on
Broken bones, bite wounds, poisoning	Yes	Yes	No
Infections, digestive and urinary illness	No	Yes	No
Cancer, diabetes, arthritis	No	Yes	No
X-rays, blood work, MRIs	For accidents	Yes	Some screening tests
Surgery and hospital stays	For accidents	Yes	No
Prescription medication	For accidents	Yes	Flea, tick and heartworm prevention
Vaccines, checkups, dental cleaning	No	No	Yes, up to set limits
Pre-existing conditions	No	No	No

What are the three types of pet insurance plans?

The three types are accident-only, accident and illness, and wellness. The first two are insurance against surprises; wellness is a budgeting add-on for planned care.

Plan type	What it covers	Average dog premium	Average cat premium
Accident only	Injuries and emergencies from accidents	$190 a year	$112 a year
Accident and illness	Injuries plus new illnesses	$836 a year	$435 a year
Accident, illness and wellness	All of the above plus routine care	$1,414 a year	$859 a year

Prices are 2025 US averages from NAPHIA, the pet insurance trade group.

Accident-only plans cover fractures, poisoning and swallowed objects, but nothing caused by illness. That includes infections and cancer. Our accident-only guide explains when that trade-off makes sense.

Accident and illness is the standard policy most people mean by pet insurance. It adds illnesses from ear infections to cancer. Our accident and illness guide goes clause by clause.

A wellness add-on is an optional extra that pays set amounts toward routine care. NerdWallet lists vaccinations, annual exams, bloodwork, flea and tick prevention, microchipping and spaying or neutering. Our wellness plans guide does the math on whether one pays for itself.

What medical care does a standard policy pay for?

A standard accident-and-illness policy pays for the full chain of care for a covered condition, from the first test to follow-up medicine. Forbes Advisor and ASPCA’s plan details point to the same core list.

• Diagnostics: blood tests, X-rays, ultrasounds, CT scans and MRIs.
• Emergency care: after-hours hospitals and urgent visits. See our emergency coverage guide.
• Surgery and hospitalization: from wound repair to orthopedic surgery. See our surgery coverage guide.
• Cancer treatment: chemotherapy, radiation and surgery. See our cancer coverage guide.
• Prescription medication: drugs and injections for a covered condition. See our medication coverage guide.
• Alternative and physical therapy: acupuncture, chiropractic care and rehab, on many plans.
• End-of-life care: Forbes Advisor lists euthanasia when a vet recommends it.

All of it is paid as a share of the bill after your deductible, the amount you pay each policy year before the insurer pays anything. The share is your reimbursement rate, usually 70%, 80% or 90%, up to your annual limit, the most the insurer pays in a year. Our deductible guide explains how they fit together.

What does pet insurance not cover?

Four things are excluded by almost every policy: pre-existing conditions, routine care, cosmetic procedures and breeding costs. Pumpkin’s list of common exclusions adds several more.

Exclusion	What it means
Pre-existing conditions	Signs or treatment before coverage began or during a waiting period
Routine and preventive care	Vaccines, checkups, parasite prevention, cleanings, unless you buy an add-on
Elective and cosmetic procedures	Ear cropping, tail docking, declawing, often spay and neuter
Breeding and pregnancy	Costs of pregnancy, birth and cesareans
Vaccine-preventable diseases	Parvovirus, distemper or rabies in an unvaccinated pet, on many plans
Grooming, food and supplements	Regular food, nail trims and grooming, per Forbes Advisor
Experimental treatment	Care not accepted as standard veterinary practice
Administration fees	Charges for filling in claim forms or getting a vet to sign them

A pre-existing condition is one your pet had signs of, or was treated for, before coverage started or during a waiting period. The NAIC model law uses that definition. Our pre-existing conditions guide covers the exceptions.

Which coverage varies by insurer?

Several common items depend entirely on the insurer, and they change your payout more than small price differences do. Check these in any sample policy.

Item	Example of the split
Exam fees	ASPCA includes them in its base plan; Healthy Paws says they are not covered
Hereditary conditions	ASPCA and Healthy Paws cover hip dysplasia; the NAIC says most insurers exclude hereditary or congenital conditions
Dental illness	Accidental tooth injuries are usually covered; gum disease varies
Behavioral therapy	ASPCA covers behavioral issues; Healthy Paws excludes behavioral treatment
Prescription food	ASPCA covers it for a covered condition; NerdWallet says availability varies
Bilateral conditions	Some insurers exclude the second side if the first was pre-existing

The exam fee is what the vet charges just to see your pet, before tests or treatment. It shows up on almost every bill.

A bilateral condition is one that can affect both sides of the body, such as cruciate ligament tears, hip dysplasia or cataracts. Healthy Paws, for example, excludes the cruciate ligament on the second leg if the first leg was injured before enrollment or during the waiting period.

Dental coverage has the widest range of rules. Our dental coverage guide sorts out injury, disease and cleanings.

Are curable pre-existing conditions ever covered?

Sometimes. A curable condition is one that can be treated and resolved, such as a bladder or ear infection. An incurable one, such as arthritis, can only be managed. Forbes Advisor says incurable pre-existing conditions stay excluded permanently.

Some insurers will cover a curable condition again after a symptom-free stretch. The length varies.

Insurer	Symptom-free period before a curable condition can be covered
ASPCA	180 days
Healthy Paws	365 days
Lemonade	12 months, in most states

This is the main reason to buy early. A young, healthy pet has nothing on its record to exclude.

Is routine care covered?

Not by a base policy, but a wellness add-on can pay part of it. Vaccines, wellness exams, flea, tick and heartworm prevention, and routine dental cleaning are all preventive care. Base policies leave them out, because they are planned costs rather than risks.

Wellness add-ons pay fixed amounts per item or up to a yearly allowance. Lemonade’s preventative packages, for example, cover a wellness exam, wellness tests, vaccines, dental cleaning and flea or tick prevention. Its puppy and kitten package adds spay or neuter, microchipping and up to six vaccines. Our guides to vaccination coverage and spay and neuter coverage price those items out.

When does coverage start?

Coverage starts after the waiting period, the stretch after you buy before claims are paid. NerdWallet reports accident waits of one to 15 days and illness waits of 14 to 30 days. Orthopedic conditions can take six months to a year.

Anything that appears during that window is treated as pre-existing. Our waiting periods guide compares insurers and the state laws that cap these waits.

Bottom line

Pet insurance covers new accidents and illnesses, including the tests, surgery, hospital care and medicine to treat them, for dogs and cats alike. Pre-existing conditions, routine care, cosmetic procedures and breeding costs are excluded almost everywhere. Exam fees, hereditary conditions, dental illness and behavioral therapy vary, so compare those clauses before price. If you want vaccines and checkups paid too, add wellness cover and check its limits.