Insurance guide, not financial advice. Prices and policy terms come from public sources and change often, so check the details of your own policy. Last reviewed September 30, 2026. How we research
In this guide
- Quick answer
- The three rules that decide your claim
- What each insurer pays toward a TPLO
- How much insurance pays back on a TPLO
- What else is covered: diagnosis, rehab and other surgeries
- How to insure a dog that’s prone to knee problems
- The bottom line
- Frequently asked questions
- How we researched this article
- Sources
Quick answer
Yes, accident-and-illness pet insurance usually covers TPLO and other cruciate ligament surgery, if three conditions are met. The tear has to happen after the orthopedic waiting period ends. There must be no sign of a knee problem in your dog’s records before coverage. And the other knee mustn’t have been injured first. Miss any one of them and the claim is usually denied, often for both knees, for life.
| Insurer | Waiting period for cruciate / knee | Can an exam shorten it? | If one knee was injured before coverage |
|---|---|---|---|
| Trupanion | 30 days (same as all illnesses) | Not applicable | A recurrence of a pre-coverage injury is pre-existing |
| Healthy Paws | 15 days (illness wait); hip dysplasia has its own 12-month wait | In 16 states, the illness wait is waivable with an exam | The other cruciate is excluded |
| Embrace | 180 days for dogs | Yes, with an orthopedic exam; in the first 14 days it ends with the illness wait | The other side is excluded |
| Lemonade | 6 months for cruciate ligament injuries | Not stated | Knee and ligament problems never count as cured |
| ASPCA | Varies by policy form and state | Not stated | Any prior knee or ligament problem excludes future ones |
| Fetch | 6 months | Yes, for knee injuries, with an exam within 180 days | The other cruciate is excluded |
Sources: each insurer’s website, checked September 2026. Rules vary by state and policy version.
Why it matters: TPLO costs $3,525 on average and $2,793 to $6,417 depending on the state, according to CareCredit. That’s per knee. A Muir et al. study found that 54% of dogs with one torn cruciate went on to tear the other one, a median of about 2.6 years later.
The three rules that decide your claim
1. The orthopedic waiting period
Several insurers wait much longer before covering knee problems than other illnesses: 6 months at Lemonade and Fetch, 180 days at Embrace. If your dog tears a cruciate ligament, or just starts limping, during that period, the knee is treated as pre-existing. Lemonade says so directly: a cruciate injury during the waiting period “would be considered a pre-existing condition and would be excluded.” See our guide to waiting periods.
2. Pre-existing signs in the records
A cruciate tear doesn’t need to be diagnosed before coverage to be excluded; a sign is enough. Insurers read your dog’s chart. A note such as “intermittent lameness, right hind” before the policy, or during the waiting period, can make that knee pre-existing. Read your dog’s records for any mention of limping or knee pain before you buy. See pre-existing conditions.
3. The other knee (bilateral rule)
At several insurers, if one cruciate was injured before coverage, the other knee is excluded too. Healthy Paws, Fetch and Embrace say so. ASPCA excludes all future knee and ligament conditions if any occurred before coverage or during a waiting period, and Lemonade says knee and ligament problems can never count as cured.
This rule matters because second tears are common. In the Muir et al. study of 380 dogs with one torn cruciate, 204 (54%) later tore the other one, a median of 947 days (about 2.6 years) after the first.
| If this happens | What’s usually covered |
|---|---|
| First tear after the waiting period, no prior knee signs | Both knees, now and later, subject to limits |
| First tear during the waiting period | Neither knee at insurers with a bilateral rule |
| First tear before you bought the policy | Neither knee at insurers with a bilateral rule; other conditions still covered |
| Limping noted in the records before coverage | That knee is excluded; the other may be too |
Sources: Lemonade; Healthy Paws; Embrace; Fetch; ASPCA; Muir et al., PLOS ONE, 2011.
What each insurer pays toward a TPLO
Beyond the waiting period, four policy details decide how much of a TPLO bill comes back: the deductible type, the annual limit, exam fees and whether rehab is included.
| Insurer | Deductible | Annual limit | Exam fees | Physical therapy / rehab |
|---|---|---|---|---|
| Trupanion | Per condition, once for life | No limit | Not covered | Alternative therapies are an optional add-on |
| Healthy Paws | Annual | $5,000, $7,000 or unlimited | Not covered | Alternative care included |
| Embrace | Annual, $100–$1,000 | You choose | Optional add-on | Check the policy |
| Lemonade | Annual, $100–$750 | $5,000–$100,000 | Optional add-on | Physical therapy add-on required |
| ASPCA | Annual, $100–$500 | Unlimited available | Included | Alternative therapies included in Complete Coverage |
| Fetch | Annual (most common $300) | Most common $10,000 | Included (up to $250 a visit) | Physical therapy and acupuncture included |
Sources: each insurer’s website and ASPCA’s published comparisons, checked September 2026.
The annual limit is the hidden trap for knees. A TPLO on each knee can cost $7,000 to $12,000 or more, and if both happen in the same policy year, a $5,000 limit could leave you paying thousands. A per-condition deductible like Trupanion’s is paid once per condition, even if treatment continues for years.
How much insurance pays back on a TPLO
On an average $3,525 TPLO, a policy with a $250 deductible and 90% reimbursement leaves you paying about $603. With a $500 deductible and 70%, you’d pay about $1,558.
| TPLO bill | $250 deductible, 90% | $250 deductible, 80% | $500 deductible, 70% |
|---|---|---|---|
| $3,525 (CareCredit national average) | You pay about $603 | You pay $955 | You pay about $1,558 |
| $6,000 (higher-cost hospital) | You pay $850 | You pay $1,450 | You pay $2,300 |
Our calculations, applying the reimbursement percentage first and then the deductible, as Healthy Paws and Lemonade do. Assumes the whole bill is covered, the annual deductible hasn’t been met and the limit isn’t reached. Exam fees may not be covered.
With Trupanion’s 90% and a $0 deductible, a $6,000 surgery would come back as $5,400, minus any exam fees and taxes, which Trupanion doesn’t cover.
Remember the costs around the surgery. Diagnosis (exam, X-rays, sedation), follow-up X-rays, medications and rehab add to the bill. CareCredit puts a first physical therapy consultation at about $180, with sessions at $58 to $98 each. Whether rehab is covered depends on your plan (see the table above). For a full breakdown of the bill, see our guide to TPLO surgery costs.
What else is covered: diagnosis, rehab and other surgeries
Once the knee is covered, the policy pays for more than the operation itself. Lemonade, for example, says that after the waiting period its coverage includes “diagnostics, surgeries, and medications” related to the injury.
| Part of the treatment | Usually covered? | Watch for |
|---|---|---|
| Diagnosis: X-rays, sedation, specialist consult | Yes | The exam fee itself may be excluded (Trupanion, Healthy Paws) or an add-on (Embrace, Lemonade) |
| The surgery: TPLO, TTA or lateral suture | Yes, for a covered condition | Your policy pays for the procedure your vet recommends, not a cheaper one |
| Medications and follow-up X-rays | Yes | Recheck exam fees follow the same exam-fee rule |
| Physical therapy and rehab | Depends on the plan | Included at Fetch, Healthy Paws and ASPCA’s Complete Coverage; add-on at Lemonade and Trupanion |
| The second knee | Yes, if the first tear happened after coverage started | Excluded at several insurers if the first knee was a pre-existing problem |
Sources: Lemonade; Trupanion; Healthy Paws; ASPCA; Fetch; Embrace.
Not sure which surgery your dog needs? TPLO, TTA and lateral suture differ in cost and suit different dogs. Compare them in TPLO vs. TTA vs. lateral suture.
How to insure a dog that’s prone to knee problems
The best time to insure a dog for cruciate surgery is before any limping shows up, ideally while it’s a puppy. Once a knee problem is in the records, no new policy will cover that knee, and often not the other one either. These steps give you the best chance of a paid claim.
- Enroll early. A long orthopedic waiting period costs little if it ends while your dog is young. Large, active breeds such as Labradors, Rottweilers and Newfoundlands are at higher risk, so don’t wait for the first sign of trouble. See our guide to pet insurance waiting periods.
- Read your dog’s records before you apply. Look for words like “lameness”, “limping”, “stiff” or “sore knee”. The insurer will read the same records when you claim. See pet insurance and pre-existing conditions.
- Book the exam that shortens the knee wait. At Embrace, an orthopedic exam in the first 14 days of the policy ends the orthopedic wait when the illness wait ends. Fetch also lets you shorten its knee wait with a vet exam. Check the deadline in your policy.
- Choose a limit that covers two knees. With second tears so common, an unlimited plan or a high annual limit protects you if both knees need surgery in the same year. A per-condition deductible means you pay it once for the knee, not every year.
- Read the bilateral clause. Search the sample policy for “bilateral”, “cruciate” or “other side” before you buy, so you know what happens if one knee is ever excluded.
- Don’t switch insurers after a knee has been treated. A new insurer would treat that knee as pre-existing, and at many insurers the other knee too.
- Have a plan for what insurance won’t pay. You’ll still pay the deductible, your share of the bill and any exam fees. See vet financing options and CareCredit for vet bills.
Ready to compare plans? See our picks for the best pet insurance for dogs.
The bottom line
Pet insurance is one of the best ways to pay for TPLO, but only if the knee is clean when you buy. Enroll before any limping, get through the orthopedic waiting period, and pick a limit that could cover both knees. If your dog already has a knee problem, a new policy won’t pay for it, so plan to use savings or financing instead. To see if coverage makes sense for your dog overall, read is pet insurance worth it?
Frequently asked questions
Does pet insurance cover TPLO surgery?
Yes, most accident-and-illness policies cover TPLO if the cruciate tear happens after the waiting period ends and there’s no sign of a knee problem in your dog’s records before coverage. Wellness plans don’t cover surgery, and accident-only plans may exclude cruciate injuries.
How long is the waiting period for cruciate ligament surgery?
It depends on the insurer: 30 days at Trupanion, 15 days at Healthy Paws, and 6 months at Lemonade and Fetch (180 days for dogs at Embrace). Embrace and Fetch let you shorten it with a vet exam.
Will insurance cover the second knee if my dog tears both?
Yes, if the first tear happened after coverage started. If the first knee was injured before coverage, Healthy Paws, Embrace and Fetch exclude the other cruciate too, and ASPCA excludes all future knee and ligament problems.
How much will I pay for a TPLO with insurance?
On the average $3,525 TPLO, you’d pay about $603 with a $250 deductible and 90% reimbursement, or about $1,558 with a $500 deductible and 70%. That assumes the whole bill is covered and you haven’t met the annual deductible yet.
Can I get pet insurance after my dog tears a cruciate ligament?
Yes, but the injured knee won’t be covered, and at many insurers neither will the other knee. The policy can still cover unrelated accidents and illnesses.
Does pet insurance cover physical therapy after TPLO?
It depends on the plan. Fetch, Healthy Paws and ASPCA’s Complete Coverage include it, while Lemonade and Trupanion need an add-on. Check your policy before surgery.
Is pet insurance worth it for a dog at risk of cruciate tears?
Often, yes. One TPLO costs $3,525 on average, and 54% of dogs in one study later tore the other knee. But it only pays off if you enroll before any knee problem shows up.
How we researched this article
We read the waiting-period, pre-existing-condition and coverage pages of six large US pet insurers (Trupanion, Healthy Paws, Embrace, Lemonade, ASPCA Pet Health Insurance and Fetch) in September 2026. When an insurer’s own page disagreed with a comparison site, we used the insurer’s page. Surgery and rehab costs come from CareCredit’s published averages. Reimbursement examples are our own calculations, applying the percentage first and then the deductible, and assume the whole bill is covered. Policy terms change and vary by state, so check the sample policy for your state before you buy.
This page has no affiliate links, and no insurer pays to be mentioned.
Sources
- Lemonade: TPLO surgery for dogs: cost and coverage; Dog ACL surgery cost; Waiting periods
- Muir P, et al. Contralateral cruciate survival in dogs with unilateral non-contact cranial cruciate ligament rupture. PLOS ONE, 2011.
- CareCredit: Dog ACL surgery cost; Dog physical therapy cost
- Healthy Paws: Coverage and exclusions; Frequently asked questions
- Embrace: Waiting period for orthopedic conditions; Waiting periods
- Fetch: Waiting period FAQ; Pre-existing conditions
- ASPCA Pet Health Insurance: Pet insurance and pre-existing conditions; What does pet insurance cover?
- Trupanion: Cruciate surgeries; When does my coverage begin?; What Trupanion does not cover