Private Health Cover for Diabetes

Almost 1.5 million Australians are living with diabetes, with up to an additional 500,000 people affected by undiagnosed type 2 diabetes. The condition often requires life-long management that can come with significant out-of-pocket costs.

Fortunately, health insurance for those with diabetes can shoulder much of that financial load. But what is actually covered by diabetes health insurance varies widely between health funds. Finding effective private health cover with an ongoing medical condition can often be a difficult task.

That's why the team at Compare Club has put together a quick guide to help Aussies better understand the nuances surrounding health insurance and diabetes.

What does health insurance for those with diabetes help with?

In Australia, exactly what is covered by health insurance for those with diabetes varies widely between insurers and policies. 

Some types of hospital cover may pay costs associated with in-patient care, surgeries, and hospital stays related to diabetes management or complications.

Depending on your particular policy, you may also be covered for some out-of-hospital services related to diabetes, such as consultations diabetes educators, podiatrists and other healthcare professionals involved in diabetes care.

Some health insurers also may help cover the cost of the items you need to self-manage your diabetes, including:

• Insulin pumps: These are small devices that deliver a continuous supply of insulin through a small tube or catheter that is placed under your skin. Some insulin pumps have integrated CGM systems.

• Blood glucose metres: These are small, portable devices that are used to measure your blood sugar levels. They typically require a small blood sample that’s obtained by pricking the tip of your finger. 

But it's important to note that waiting periods, exclusions, and limitations may apply, so it's crucial to carefully review the terms and conditions of your health insurance policy.

What types of diabetes can health insurance help with?

• Type 1 Diabetes: Also known as insulin-dependent diabetes, type 1 diabetes is an autoimmune condition where the immune system attacks and destroys the insulin-producing beta cells in the pancreas.

The best private health insurance for type 1 diabetes will cover many of your hospital and treatment costs. 

• Type 2 Diabetes: Often linked to lifestyle factors, type 2 diabetes is characterised by insulin resistance, where the body's cells do not respond effectively to insulin.

  Many insurers provide hospital and extras cover for the management of type 2 diabetes.

How much do insulin pumps cost?

Let’s start with the bad news. Insulin pumps can cost anywhere between $5,000 to $10,0005 in Australia – and are typically not covered by Medicare or the National Diabetes Services Scheme (NDSS).

But it gets better. Some private health insurers do cover insulin pumps under certain hospital policies. This typically means that the best private health insurance for insulin pumps will cover the cost of insulin pumps provided as part of a hospital admission2.

On the other hand, if your insulin pump is provided as an out-of-hospital treatment, there’s no guarantee that your health insurance will cover it. Some health funds will heavily subsidise the cost of an out-of-hospital insulin pump, but you’ll need to check carefully with your insurer.

Understanding the law behind your health cover

It's important to remember that in Australia, health insurance companies are legally not allowed to discriminate against anyone with any chronic illness, including diabetes.

However, they can enforce longer waiting periods for existing conditions (with a limit of 12 months).

The waiting period only applies if you're new to health insurance, or upgrading your health cover.

A health insurer cannot refuse to insure you, and they cannot charge you higher premiums than someone without diabetes.

Despite this legal assurance that you won't be penalised for having diabetes, what you do need to consider are the ongoing expenses related to managing your condition.

Frequently Asked Questions

How much does insulin cost in Australia?

The cost of insulin in Australia varies between insulin type, brand and pharmacy. However, in general terms, the average price of insulin in Australia is around $10.63 per standard unit. Insulin is generally available to those with insulin dependant diabetes via the Pharmaceutical Benefits Scheme (PBS).

Will diabetes affect my private health insurance?

In Australia, health insurance companies are legally not allowed to discriminate against anyone with a health condition, including diabetes. They also can’t refuse to insure you or charge you higher premiums because you have diabetes.

However, they can enforce a 12 month waiting period for existing conditions). But waiting periods only apply if you're new to health insurance, or upgrading your health cover.

How can the National Diabetes Services Scheme (NDSS) help reduce my out-of-pocket costs?

The NDSS helps to reduce out-of-pocket expenses for people managing diabetes with subsidised or free access to diabetes-related products, education, and support services. 

This includes blood glucose test strips, insulin syringes, insulin pump consumables, and other essential items. 

Registration is open to Australian residents who have been diagnosed with diabetes by a medical professional.

How can I find the best health insurance for diabetics? There is no one-size-fits-all policy for those with diabetes. If you're struggling to understand how to best cover your diabetes, the friendly health insurance experts at Compare Club are here to help.

Sources

Diabetes Australia, About Diabetes

Commonwealth Ombudsman, Diabetes and Insulin Pumps Diabetes Australia, ​​Navigating the World of Insurance

Australian Government Department of Health and Aged Care, National Diabetes Services Scheme (NDSS) Cairns Diabetes & Endocrinology, Insulin Pumps: WiseVoter, Cost of Insulin by Country:

Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

• 1

  Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.

• 2

  An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.

• 3

  Family health cover means your children are covered under the same policy as you.

• 4

  Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).