95% of Pets Are Uninsured: How Affordability Is Changing Veterinary Clinic Demand in the U.S.

Only 6% of dogs and 2% of cats in the U.S. have insurance. The clinics closing that gap aren't waiting on insurers. They're winning on timing.

At a Glance

• Only 6% of dogs and 2% of cats in the U.S. have insurance. (NAPHIA, 2025)
• 52% of pet owners skipped care their pet needed last year. 71% blamed cost. (PetSmart Charities-Gallup)
• 64% say a payment plan would have doubled what they could afford. Only 23% ever got offered one. (same study)
• 11,500 U.S. clinics now bill insurers directly at checkout, about a third of the country's vet hospitals. (Trupanion)
• 36% of large employers now offer pet insurance as a benefit, up 22% in five years. (Mercer)

Only about 6% of dogs and 2% of cats in the United States had insurance in 2025. That covers roughly 6.98 million of the country's estimated 163.6 million dogs and cats, according to NAPHIA's 2026 State of the Industry Report.

The number of insured pets grew 9% from the year before, and the money paid in premiums grew even faster, up nearly 20% to $5.68 billion. So the category is expanding fast, just from a small base. More than 95% of pets in this country are still uninsured.

That number sounds like a crisis. Read it as a diagnostic instead, and it's more useful. With insurance this rare, clinics shape their own demand. More than the underwriters and the insurers, what happens inside the clinic is driving it, especially at the exact moment a client decides whether to say yes to an estimate.

The tools that actually get more pets seen and treated step in before the bill exists, or right at the point of sale. Tools that step in after the bill, like financing, still matter. But by then, the clinic has usually already lost that decision once.

More Than 50% of Pet Owners in the U.S. Reported Skipping Clinic Visits, Only Due to High Costs

Low insurance doesn't cost clinics mostly through bad debt. It costs them recommendations that never make it onto the invoice at all.

"52% of U.S. pet owners reported skipping needed veterinary care in the past year. 71% of those who declined pointed to cost, and the pattern held even among households earning $90,000 or more."

Source: PetSmart Charities-Gallup State of Pet Care Study, fielded Nov 2024-Jan 2025

The breakdown, by the numbers:

• 37% of owners visited a clinic and declined a specific recommendation. 15% avoided the visit entirely, per the same Gallup study cited above.
• One in three pet owners earning $90,000 or more who declined care said they simply couldn't afford it, per Gallup. This isn't just a low-income problem. It's a timing problem.
• 73% of owners who declined care say nobody offered them an alternative, per AVMA.
• 64% say a payment plan could have doubled what they could afford. Only 23% ever got offered one, per AVMA.
• What owners decline first, per AVMA: diagnostics (22%), preventive care like vaccines (18%), elective surgery (16%), medications (11%), lifesaving surgery (7%).
• 14% of owners who declined care said the pet's condition worsened, or the pet died, per AVMA.

The most useful number here isn't a headline figure, it's a gap: 64% versus 23%. The tool existed, but nobody offered it when the client needed it, and that gap is the argument for the rest of this piece.

Wellness Plans and Early Insurance Conversations Beat Financing After the Bill

The in-clinic tools working right now aren't more generous than what came before. They just show up earlier, before a client ever declines an estimate.

1. Pre-paid wellness plans. Bundle vaccines, dentals, and annual exams into a flat monthly subscription. One large, unpredictable bill becomes several small, predictable ones, well before that bill would otherwise catch an unprepared client off guard.
2. Insurance conversations at the first visit. Raising insurance at a puppy or kitten's first appointment works the same way, but there's a deadline: it only works before pre-existing condition exclusions kick in. A script that mentions insurance at month six instead of week two isn't offering the same thing, even if it sounds close.
3. Third-party financing (CareCredit, Scratchpay). Genuinely useful, worth having, and reactive by design. It only kicks in once a client already can't cover a bill in full. By then, the "let's run the full workup" conversation has usually already happened once, and been lost once, before financing rescues a smaller version of it.

Here's the difference that actually matters: wellness plans and early insurance talks solve the money question before a client ever has to make a hard decision. Financing only shows up after a client is already stuck with a bill they can't pay. A clinic needs both, but they're not solving the same problem. If a clinic only offers financing, it's showing up too late to stop the client from declining care in the first place.

Case Study: How Three U.S. Vet Clinics Solved Cost-Related Client Churn

This isn't just statistics and theory. A handful of clinics already saw the affordability gap coming and built their own fix before anyone told them to. Banfield, Heart + Paw, and Friendship Hospital for Animals each understood the same problem, worked at completely different scales, and landed on a version of the same answer: turn one large, unpredictable bill into several small, predictable ones, before it ever becomes a decision a client has to make alone.

Banfield set the national playbook. Banfield built its Optimum Wellness Plans around separate life-stage packages, one each for puppies, kittens, adult dogs, and adult cats. Every package bundles unlimited office visits with scheduled vaccines, bloodwork, fecal exams, and parasite screening, and dental cleanings can be added on top. The unlimited exam visits matter most, because they remove the "is this worth an exam fee" hesitation right when a client first notices something off. That's this whole piece's argument, built into one product feature.

Heart + Paw automated the same idea for a 29-location network. Instead of one rigid package, Heart + Paw runs age-based plan tiers a vet can customize inside the exam room, adding a lifestyle vaccine for a dog that hikes or adjusting flea and tick prevention to fit the pet's actual environment. Multi-location groups should notice the backend here. Billing runs through software, not staff manually re-running charges every month. That's what lets the plan scale without becoming a burden at every location.

Friendship Hospital turned a wellness plan into an emergency hedge. Even large, independent, 24-hour hospitals use this model to keep clients loyal. Friendship, a premier practice in Washington, D.C., offers wellness plans that go beyond vaccines and parasite testing: up to $100 off dental cleanings, 15% off preventive medications. Because Friendship runs 24 hours, wellness members also get discounts on emergency and specialty exam fees. So the plan doesn't just smooth cost before a bill. It cushions cost during one too, in the same plan.

Insurers Now Pay Vets Directly at Checkout, Instead of Making Owners Wait Weeks

The insurance industry's biggest recent shift isn't pricing. It's timing, the same shift wellness plans already proved works at the clinic level.

For most of the industry's history, pet insurance made owners pay the full bill upfront and wait weeks for reimbursement. The insurance existed on paper, but it didn't help at the moment that actually mattered, the front desk, at checkout.

"VetDirect Pay is integrated at roughly 11,500 clinics across the U.S., Canada, and Australia as of late 2025, about a third of the 28,000 veterinary hospitals in the U.S. 75% of claims process within 24 hours, some in as little as five seconds, and the system automates more than 60% of claims end to end."

Source: Trupanion

The client pays only their deductible and co-insurance, often before leaving the exam room. Insurers are simplifying policies too, swapping confusing deductible math for fixed, easy-to-explain coverage. That lets front-desk staff quote a client's real out-of-pocket cost during the estimate, not after a claim gets filed and processed.

Put plainly: direct pay does for insurance claims what a wellness plan does for preventive care. It closes the gap between the bill and the payment.

Employers Are Expanding Pet Insurance Coverage, Non-Profits Are Catching What Falls Through

More pet insurance decisions are now made by HR departments, not individual pet owners shopping on their own. That matters because it removes the biggest barrier there is: the pet owner no longer has to go find and sign up for a policy themselves.

On the employer side:

• 36% of large U.S. employers (500+ workers) offered pet insurance as a voluntary benefit by 2022, up 22% from five years earlier, per Mercer research via HR Dive
• Nationwide says 70% of its pet insurance business now comes through employer-sponsored plans
• Buying through an employer's group plan is usually cheaper than buying a policy alone
• Some employers now offer general lifestyle stipends staff can put toward premiums or vet bills

On the non-profit side:

• Larger hospitals now employ veterinary social workers who help clients find emergency grants, set up crowdfunding, or work through end-of-life financial decisions
• Humane societies are expanding subsidized, low-cost urgent care clinics to absorb baseline emergencies that would otherwise land straight on a private practice's doorstep

Both act as the safety net under everything else in this piece, catching cases that slip through wellness plans, direct pay, and employer benefits. There's an ethical upside too: it moves the weight of economic euthanasia decisions off individual private-practice staff and onto institutions built to carry it.

Your 6-Step Action Plan to Close the Affordability Gap at Your Clinic

None of the tools in this piece work on their own. Here's the order to actually put them in place, based on everything above.

1. Measure your baseline first: Pull your own numbers before you add anything new. How often does a client decline a recommendation over cost? How often does that show up as a no-show or a downgraded treatment plan? You can't tell if a fix is working if you never measured the problem.
2. Fix your wellness plan, or build one: If you don't have one, this is the highest-leverage step on this list, look at Banfield, Heart + Paw, or Friendship Hospital for the model that fits your size. If you already have one, check whether it's actually removing hesitation at the exam-fee level, the way Banfield's unlimited visits do, or whether it's just another line item clients have to be sold on.
3. Move the insurance conversation to a puppy or kitten's first visit: Not the third visit, not the annual exam. The first one, before pre-existing condition exclusions can apply. Put it in the intake script so it doesn't depend on one staff member remembering.
4. Switch to direct-to-clinic billing wherever you can: If you're not integrated with something like Trupanion's VetDirect Pay, insured clients at your practice are still waiting weeks for reimbursement instead of paying only their deductible at checkout. That's a solved problem you're not using yet.
5. Keep financing in place, but stop treating it as your main fix: Third-party financing options are strong, and worth offering to every client. They're built to catch a bill after it's already on the table, so they work best alongside wellness plans and early insurance conversations, not in place of them.
6. Know your safety net for the cases nothing else catches. Make sure your team knows how to point clients toward employer-sponsored pet benefits when relevant, and keep a current referral list for local subsidized or non-profit urgent care. Some cases will fall through everything above, and having that list ready is what keeps it from becoming an economic euthanasia decision made under pressure.

Do these in order. A clinic that jumps straight to step 4 without fixing step 2 is still leaving its biggest lever, the wellness plan, on the table. The 95% figure from the start of this piece isn't a problem the industry needs to fix from outside. It shows you exactly which of these six steps your clinic hasn't taken yet.

A few specific questions come up often once clinics start putting these steps in place. Here are the ones worth answering directly.

Frequently Asked Questions

What percentage of pets in the U.S. actually have insurance right now? 

About 6% of dogs and 2% of cats had insurance in the U.S. in 2025, covering roughly 6.98 million pets out of an estimated 163.6 million dogs and cats nationwide, according to NAPHIA's 2026 State of the Industry Report. The number of insured pets grew 9% from the year before, and the money paid in premiums grew nearly 20%, to $5.68 billion. The industry is expanding faster than the raw percentage suggests. Even so, more than 95% of pets remain uninsured, which is the gap this piece is about.

If payment plans exist, why are so many pet owners still declining care over cost? 

Because the tools often don't reach clients at the moment they'd actually use them. In the PetSmart Charities-Gallup State of Pet Care Study, 73% of pet owners who declined care said nobody offered them an alternative, and 64% said a payment plan could have doubled what they could afford, yet only 23% ever got that offer. The gap isn't that affordability tools don't work. It's that they're often missing from the conversation exactly when a client needs them.

What is direct-to-clinic billing, and how is it different from how pet insurance used to work? 

Traditionally, pet insurance made the owner pay the full bill at checkout and wait weeks for reimbursement. Direct-to-clinic billing, like Trupanion's VetDirect Pay, reverses that: the insurer pays the hospital directly, often before the client leaves the exam room, and the client covers only their deductible and co-insurance on the spot. As of late 2025, the system runs at roughly 11,500 clinics across the U.S., Canada, and Australia, about a third of all U.S. veterinary hospitals, and Trupanion says 75% of claims process within 24 hours.

Are employers actually offering pet insurance as a benefit, or is that mostly marketing? 

It's real, and it's growing. Mercer research found that 36% of large U.S. employers (500 or more workers) offered pet insurance as a voluntary benefit by 2022, up 22% from five years earlier. Nationwide now says 70% of its pet insurance business comes through employer-sponsored plans, according to HR Dive. Group plans typically carry a lower rate than buying individually, which is part of why this channel is growing faster than direct-to-consumer sales.

Are wellness plans, like the ones Banfield or Heart + Paw offer, the same thing as pet insurance? 

No, and it's worth explaining the difference to clients clearly. A wellness plan is a subscription the clinic itself sells, prepaying for known, routine services like exams, vaccines, and bloodwork on a monthly basis. Pet insurance comes from a separate insurance company, which reviews the pet's health and sets a price before covering it. It pays for unpredictable illness or injury costs, not routine care. They solve different problems: predictable expenses versus unpredictable ones. The strongest clinics, like Friendship Hospital for Animals, use both together instead of treating one as a substitute for the other.

The affordability gap in veterinary care isn't closing because insurers are moving faster. It's closing because clinics are refusing to wait for them. Every tool in this piece, wellness plans, first-visit insurance conversations, direct billing, financing, employer benefits, non-profit safety nets, does the same thing at a different point in the timeline: it puts a plan in front of a client before cost forces a decision for them. Start with whichever step on your list is still missing. That's the whole strategy.