Does pet insurance cover pre-existing conditions?

When it comes to pet insurance, one of the most common questions pet parents ask is, “Does pet insurance cover pre-existing conditions?” Understanding how these conditions affect your ability to secure coverage is crucial, especially if your furry companion has already faced health challenges.

To help you understand the fine print, you should get familiar with what constitutes a pre-existing condition, how different insurers handle them and what options might be available to help ensure your pet gets the care they need, even with a prior diagnosis.

Pet insurance coverage for pre-existing conditions

A pre-existing condition refers to an illness, injury or symptom your pet has before the start date of their insurance policy or during the waiting period that applies to some conditions after coverage begins.

Unfortunately, most pet insurance policies do not cover pre-existing conditions. If your pet has a medical issue before you purchase insurance, your insurance provider will typically not cover treatment for that condition — at least for a specified period. However, pet insurance companies have different policies, so check your policy carefully for details.

Classifications for pre-existing conditions

When it comes to pet insurance, understanding how pre-existing conditions are classified is crucial for pet owners seeking coverage for their furry companions.

Curable pre-existing conditions

Some pre-existing conditions are considered curable. This means that the condition can be resolved or managed effectively with treatment. While coverage for curable pre-existing conditions may vary among insurers, some policies offer coverage after a waiting period or if the condition has been symptom-free for a certain period.

• Examples of curable conditions include:

  • Broken bones
  • Certain types of skin conditions
  • Cuts and bruises
  • Diarrhea and vomitting
  • Ear infections
  • Eye infections
  • Kennel cough
  • Non-chronic vomiting and diarrhea
  • Respiratory infections
  • Bladder or urinary tract infections

Incurable pre-existing conditions

Other pre-existing conditions are considered incurable, meaning that they cannot be fully resolved with treatment. Since these conditions require ongoing management and treatment, most pet insurance companies will not provide coverage for them.

• Chronic conditions that fall into this category include:

  • Allergies
  • Arthritis
  • Bladder crystals
  • Cancer
  • Chronic kidney disease
  • Diabetes
  • Elbow dysplasia
  • Epilepsy
  • Heart disease
  • Hip dysplasia

Bilateral conditions

Bilateral conditions refer to conditions that affect both sides of the body. These may present unique challenges in terms of coverage.

For example, if your pet has hip dysplasia in their left hip before the start of the insurance policy, your insurance company may not reimburse treatment costs if they later develop hip dysplasia in the right hip.

• Examples of conditions that may occur bilaterally include:

  • Cataracts
  • Cruciate ligament tears
  • Elbow dysplasia
  • Hip dysplasia
  • Luxating patella

Hereditary or congenital conditions

Some pre-existing conditions are congenital or hereditary, meaning they are present at birth or develop early in life due to genetic factors. Many pet insurance providers will not cover these conditions, especially if they are diagnosed within a specified timeframe after the policy starts.

• Examples of hereditary or congenital diseases and conditions include:

  • Addison’s disease
  • Allergic skin disease (golden and labrador retrievers, German shepherds)
  • Brachycephalic syndrome (in pugs, English bulldogs, French bulldogs, Boston terriers and Persian cats)
  • Chondrodysplasia (dachshunds, basset hounds)
  • Certain types of cancer, such as lymphoma, hemangiosarcoma, osteosarcoma, mast cell tumors
  • Dilated cardiomyopathy (Dobermann pinschers, Great Danes, Irish setters and boxers)
  • Elbow dysplasia
  • Hip dysplasia
  • Hypertrophic cardiomyopathy (Maine coon and ragdoll breeds)
  • Hypothyroidism
  • Patella luxation (Pomeranian, Chow Chow, cocker spaniel)

How insurers determine pre-existing conditions

Insurers typically determine pre-existing conditions based on your pet’s medical history and previous veterinary records.

When you apply for pet insurance, they may ask you to disclose any pre-existing conditions your pet has or has had. Failure to disclose this information accurately could result in denial of coverage or cancellation of the policy.

Some insurance providers will request a recent vet check-up to establish a baseline of your furry friend’s health.

Medical history review

To prevent disappointment down the line, some insurance providers may offer the option to request a review of your pet’s medical history. This assessment provides a comprehensive overview of which conditions will classify as pre-existing for your pet.

If your insurer distinguishes between curable and incurable conditions, this review can also inform you which of your pet’s issues may qualify for coverage after a symptom-free duration.

How to find insurance options for pets with pre-existing conditions

If your four-legged friend has a pre-existing condition, finding insurance coverage can be challenging but not impossible.

Some insurers may offer limited coverage for certain pre-existing conditions, especially if they consider the condition curable or if the pet has been symptom-free for a specified period.

Additionally, some insurers specialize in providing coverage for pets with pre-existing conditions. In these cases, premiums may be higher and coverage limits may be lower than those of standard policies.

Pet insurance companies that cover pre-existing conditions

Is coverage for pre-existing conditions high on your priority list when choosing pet insurance? Many of the best pet insurance companies offer reimbursement for some common pre-existing conditions. Here are a few.

ASPCA

ASPCA’s pet health insurance plan covers curable pre-existing conditions if they are cured and treatment-free for 180 days. This excludes knee and ligament injuries.

Embrace

Embrace will cover curable pre-existing conditions if your furry friend is treatment- and symptom-free for a year.

Hartville

With the exception of knee and ligament conditions, Hartville’s insurance policies will reimburse for the treatment costs of pre-existing conditions after a treatment- and symptom-free period of 180 days.

Lemonade

In some states, pets whose pre-existing conditions are cured and symptom-free for 12 months, may be covered by your Lemonade policy.

ManyPets

Unless your pet has had hip dysplasia or a cruciate ligament injury, ManyPets will cover future claims for pre-existing conditions that are free of treatment and symptoms for 18 months.

MetLife

If you switch insurance policies, a new provider may consider conditions diagnosed during the previous policy term as pre-existing. You will therefore lose coverage of these conditions when changing to a new insurance company. MetLife is a little different — it will cover conditions previously reimbursed by your former insurance company.

Nationwide

Nationwide’s policies will reimburse for curable pre-existing conditions that are symptom-free for six months. You just need your vet to provide proof in the form of medical records.

Progressive

Progressive pet insurance will help cover the costs of curable pre-existing conditions.

Spot

Spot’s pet insurance will cover curable pre-existing conditions if they are treatment- and symptom-free for 180 days. This excludes knee and ligament injuries and conditions.

How to decide if you should get insurance for a pet with pre-existing conditions

Choosing whether to take out pet insurance for your furry companion if they have a pre-existing condition can be a challenging decision.

1. Cost of treatment

Evaluate the ongoing costs associated with treating your pet’s pre-existing condition. Consider expenses such as medications, veterinary visits, diagnostic tests and any potential surgeries or procedures.

Compare these costs to a pet insurance policy’s premiums and potential coverage limits.

2. Exclusions and limitations

Review the terms and conditions of the pet insurance policies carefully to understand the coverage and exclusions for your pet’s pre-existing condition. Some insurers may offer limited reimbursement for certain aspects of treatment, while others may exclude coverage altogether.

Consider whether the coverage provided by the insurance policy outweighs the out-of-pocket expenses for treating your pet’s condition.

3. Future health concerns

Consider the likelihood of your pet developing additional health issues in the future. While a pre-existing condition may be a significant factor in your decision to purchase insurance, it’s essential to consider the potential for future illnesses or injuries that may not be related to the pre-existing condition.

Insurance can provide peace of mind that your pet’s future health care needs will be covered.

4. Alternative financing options

Pet insurance may be prohibitively expensive if your pet is older or has one or more pre-existing conditions. In this case, exploring alternative financing options for covering your pet’s medical expenses, such as setting up a dedicated savings account, might be a more viable option.

5. Pet insurance alternatives

Companies like Pawp offer an emergency fund as an optional membership add-on. For a relatively small monthly fee, you can apply for up to $3,000 toward an emergency vet bill, regardless of whether it is for a pre-existing condition.

Another option is a veterinary discount plan like what Pet Assure offers, which gives you discounts on medical services and procedures at participating veterinary clinics.

Ultimately, taking out pet insurance for a dog or cat with a pre-existing condition depends on your pet’s health care needs, financial situation and risk tolerance. Weigh the costs and benefits carefully. Consult with your veterinarian and insurance provider to make an informed decision that is best for you and your furry companion.

The bottom line

Deciding whether to get pet insurance when your furry friend has a pre-existing condition can be a difficult choice. While many insurers don’t cover these conditions, there are options for some curable cases, and specialized providers may offer limited coverage. Carefully weighing the costs, exclusions and potential future health needs of your pet is crucial.

Remember, insurance isn’t your only option — consider alternatives like savings plans or discount programs. Ultimately, the right choice depends on your pet’s unique needs and your financial situation.

Frequently asked questions

• Are hereditary conditions considered pre-existing conditions?

  Yes, hereditary conditions are often considered pre-existing conditions in pet insurance policies. Insurance companies typically assess pre-existing conditions based on the pet’s medical history, which includes any hereditary conditions disclosed by the pet owner.

  Coverage for hereditary conditions can vary among insurers, with some policies excluding coverage altogether and others offering limited coverage or requiring additional riders or endorsements. Pet owners must inquire about coverage for hereditary conditions when selecting a pet insurance policy and carefully review the terms and conditions to understand the extent of coverage provided.

• Is it worthwhile to take out pet insurance if my dog or cat has a pre-existing condition?

  Deciding on pet insurance for a pet with a pre-existing condition depends on numerous factors. Consider treatment costs for the pre-existing condition, policy coverage, potential future health issues and alternative financing.

  Assess expenses vs. premiums and how these relate to your budget. Also, review policy exclusions and consider future health concerns. Explore specialized coverage options if available. Consult with your veterinarian and insurer to make an informed decision.

• Are symptoms considered indicative of a pre-existing condition?

  If a pet has exhibited symptoms of a medical issue before the start or during the waiting period of the insurance policy, those symptoms may classify as pre-existing.

  When applying for pet insurance, it’s essential to disclose any symptoms or medical history accurately to avoid issues with coverage later. Insurers assess pre-existing conditions based on the pet’s medical history, including any symptoms reported by the pet owner or documented by a veterinarian.

• Why do pet insurance companies not cover pre-existing conditions?

  Pet insurance companies generally do not cover pre-existing conditions for the following reasons:

  • Cost control: By excluding pre-existing conditions, insurers can keep premiums lower for all customers, making pet insurance more affordable.
  • Fairness: To ensure fairness among policyholders, insurers typically exclude pre-existing conditions to avoid situations where people only purchase insurance after their pet becomes ill.
  • Preventing fraud: Excluding pre-existing conditions helps prevent fraudulent claims where pet owners might attempt to get coverage for known health issues after the fact.
  • Risk management: Covering pre-existing conditions would expose insurers to significant financial risk, as they would have to pay for already known conditions and potentially costly.