Private Health Cover For Insulin Pumps

Living with diabetes can make life challenging enough without adding the cost of insulin pumps and other treatments on top of the concerns about your health.

Fortunately, some health insurance policies help cover these costs and make life more manageable for you.

Below, we’ll outline everything you need to know about health insurance coverage for insulin pumps and other diabetes-related matters:

How much does an insulin pump cost in Australia?

In Australia, insulin pumps cost anywhere from $5,000 to over $10,000*.

Before you despair, however, it's important to note that some health insurance providers will either cover the entire cost of your pump or at least heavily subsidise it, sometimes bringing your out-of-pocket expenses down from several thousand dollars to less than $200*.

Are insulin pumps covered by Medicare?

Unfortunately, Medicare doesn’t cover the cost of insulin pumps, nor does it cover the cost of any consumables you may need.

That said, Medicare will cover certain diabetes-related services and if you have a Medicare Card, you may be eligible for subsidies on other equipment such as infusion sets and reservoirs via the National Diabetes Service Scheme (NDSS)^.

Who is eligible for an insulin pump?

In Australia, insulin pumps are generally only offered to help people manage Type 1 diabetes.

While they are used to manage Type 2 diabetes in other countries such as the United States, this use is extremely rare in Australia#.

Even if you have Type 1 diabetes, there is no guarantee that an insulin pump will be your recommended treatment.

Speak to your diabetes specialist to determine whether insulin is the right treatment for your condition.

Is diabetes covered under health insurance?

The good news is that most health insurance providers will cover diabetes treatments such as insulin pumps. However, this all depends on getting the right kind of policy in place.

This doesn't necessarily mean that you need the most expensive plan, but you do need one that best suits your needs*.

Our handy health insurance comparison tool can help you assess various policies and find a cover for your particular needs.

Is Type 2 diabetes a pre-existing condition?

Type 2 diabetes is far more common than Type 1. It's classed as a pre-existing condition only if the signs or symptoms existed prior to starting your insurance policy. It doesn’t need to be formally diagnosed to be considered a pre-existing condition.

How will my private health fund cover me if I need an insulin pump?

The Private Health Insurance Act 2007 states that insulin pumps can be covered by health insurance providers as part of their Hospital or General Treatment policies.

How your pump is covered all depends on your policy.

As long as you have an appropriate hospital policy in place, your health insurer is legally obliged to pay benefits towards the cost of your insulin pump, if it’s provided as part of your hospital treatment.

That's not to say that the only way to access cover is to go to the hospital.

Since pumps are often provided without the need for hospital admittance, you'll find that some insurers will cover this cost anyway.

Again, this all depends on having the right policy in place. Find out more about hospital cover here.

Am I covered if my insulin pump needs replacing?

The majority of insurers usually let you claim for a replacement after you've used your existing pump for a certain period of time.

This is generally around 4-5 years, though some funds may allow for replacements much sooner.

Are insulin pumps on the Prostheses List?

In 2011, the Australian Government Department of Health ensured that insulin pumps were permanently included on the Prostheses List**.

This means that private health insurers are required by law to pay a benefit for the pump, providing the following criteria are met:

• You receive your pump as part of hospital treatment or a substitute treatment.

• You have the right level of health insurance cover for insulin pumps.

• You receive your insulin pump as part of a service for which Medicare offers a benefit**.

What other diabetes treatments are covered by health insurance?

This all depends on what Extras cover you have in your policy, as well as the individual health fund. Extras cover is covered in our guide.

With the right "extras" cover in place, your provider may also offer a rebate if you need to buy a self-glucose monitoring device, but they’re unlikely to cover consumables such as pump sets and lines. Likewise, certain sensors are unlikely to be included^.

On the plus side, there are health insurance providers who will cover the cost of seeing a properly qualified professional to educate you about your condition and how to manage it. How long are waiting periods for insulin pumps?

As with most health issues, a waiting period applies before you can claim for your insulin pump on a new policy.

If your diabetes is a pre-existing condition, then the standard 12 month waiting period may apply.

If it's a new condition that’s diagnosed after your policy starts, then a two-month waiting period might apply. Waiting periods are explained further in this guide.

Some health insurers may be willing to waive this waiting period, or at least significantly reduce it. It's worth shopping around for the right deal. Read more about this here.

Use our free policy comparison tool today to find a health cover for you or talk to our team for more helpful advice on insulin pump health insurance cover.

Sources

*Cairns Diabetes & endo.com.au ^Medtronic-diabetes #Insulin pumps in general practice `Health Ombudsman **Prostheses List

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

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

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