We signed up with Trupanion a few days after we brought our puppy home. A friend of ours has had a dog with numberous health issues and recommended getting insurance right away, as it would have saved her a significant amount of money. Our puppy has proved to be a typical puppy getting into trouble when he can and we've had a few visits to the ER. In both cases Trupanion covered 90% of our costs. It has more than paid for itself and we are so thankful to have it. I still think Trupanion is the best option out there, although I have no personal experience with the others. No reason for me to even consider switching, Trupanion has been amazing!