Health insurance for insulin pumps

What are insulin pumps?

Insulin pumps are little devices that give you insulin all the time through a tiny tube under your skin (though newer ones are tubeless, which is way better). Instead of shots, they give you a steady drip of insulin (basal) and extra when you eat (bolus). This can help manage diabetes better, give you more freedom with meals and exercise, and mean fewer needle sticks. Honestly, it can be potentially life saving for folks with type 1 diabetes. That said, pumps aren't for everyone, so talk to your doctor.

Does Medicare cover insulin pumps?

Medicare in Australia does not directly cover the cost of insulin pumps. Instead, access is typically through private health insurance, which may cover some or all of the cost depending on the policy. The Insulin Pump Program (IPP) offers some subsidy for those under 21 with type 1 diabetes meeting specific criteria, while others may choose to self-fund.

While the pump itself isn't covered by Medicare, consumables like reservoirs and infusion sets are partially subsidised through the National Diabetes Services Scheme (NDSS), as are Continuous Glucose Monitors (CGMs) for eligible individuals. Again, talk to your GP to figure out what you're eligible for, and what's the best fit for you.

Thanks to not being available under Medicare, insulin pumps aren't as common in Australia as other countries, which kinda sucks. Diabetes Australia has argued that Medicare should be fully funding insulin pumps for way more Aussies, so that they can be affordable for people who can't afford private health insurance, who are typically more financially well-off.

How does private health insurance cover insulin pumps?

All gold-tier hospital policies are required to cover insulin pumps. Gold policies are some of the most expensive out there, but you can also find cover on some Silver Plus policies, which will generally run a bit cheaper. There are some differences between heath funds though, especially around whether you can get cover outside of a hospital.

• In hospital: If an insulin pump is provided during a hospital stay, and you have the insulin pumps included in your hospital cover, then your insurer has to contribute to the cost of the pump, in addition to hospital accommodation and medical fees. That wording it a bit weird, but it basically means that if you get a pump as part of a hospital visit, it will be partially or fully covered.
• Out of hospital: Insurance companies aren't required to pay for insulin pumps if you get one without being in the hospital, or if your hospital stay isn't considered medically necessary. However, some health funds might still offer coverage even if you're not hospitalised. It really is fund by fund - HIF for example won't cover out-of-hospital pumps, while Teachers will pay for the cost of the pump itself, but not the out-of-hospital facility or doctors fees.

If you're thinking about insulin pumps, you should call your health fund and see what its policies are. If your current fund doesn't offer what you want, you can switch health funds pretty easily - your already served hospital waiting periods will be honoured. Of course, you should call any prospective health fund to be sure that it has better policies.

Caitlin's story

"I've had type 1 diabetes since I was 13 years old (I'm 26 now). With an insulin pump. I take a short acting insulin intravenously throughout the day, administered via an insulin pump. I am with ahm and have its Silver Plus Hospital and Lifestyle Extras cover. My current insurance policy covers the cost of an insulin pump every 4 years, if my health professional says it's a necessary item and completes all the paperwork."

Caitlin

Type 1 diabetic

Waiting periods for insulin pump coverage

Before you are able to claim for an insulin pump on your hospital cover, you'll need to serve a 2-month waiting period. This period will extend to 12-months if you have a relevant pre-existing condition. This will certainly include diabetes, but may also apply if you're pre-diabetic, had gestational diabetes when pregnany or even if you're overweight and at risk of diabetes.

Insulin pump replacement with health insurance

Other diabetic treatments and health insurance

You'll be covered for general diabetes management in hospital with a Bronze tier hospital policy - that particular category specifically excludes insulin pumps, but includes a range of other services that you might need during a hospital stay for diabetes.

Some extras insurance policies can pay for diabetes consumables, such as blood glucose monitoring devices, test strips and meters. Many health funds will also cover the cost of dietary education services, podiatry, optometry and give you money off gym memberships, exercise classes and personal training sessions.

Frequently asked questions

• Does private health insurance cover insulin pumps?

  Insulin pumps are covered on all gold-tier private health insurance policies in Australia. However, each fund has different rules about whether you can get a pump paid for when you're out of hospital. Check with your fund for details.

• Does Medicare cover insulin pumps in Australia?

  No, Medicare does not cover insulin pumps in Australia. However, the Type 1 Diabetes Insulin Pump Program does provide fully subsidised insulin pumps to children with type 1 diabetes who are from low income families, and the NDSS has some coverage options for diabetes consumables.

• What are the waiting periods for insulin pumps?

  Health insurance with insulin pump coverage typically has a 2-month waiting period if you do not have a pre-existing condition. If you have a pre-existing condition, there will be a 12-month waiting period before you can receive a benefit.

• Am I covered if my insulin pump needs replacing?

  If you need to replace an insulin pump, most funds will only pay benefits if you have used your existing pump for a specified period of time. Although those time limits vary between funds, they're commonly around 4 or 5 years. With this in mind, check with your fund to find out what benefits you are eligible for before you have an insulin pump replaced.

  If your pump needs to be repaired it may be under warranty, so get in touch with the manufacturer to find out whether it will be covered. If the warranty period has ended or the repair is simply not covered, check with your private health fund to see if it will provide the financial support you need.

• Are insulin pumps on the Prostheses List?

  Yes, insulin pumps are included in Section C of the Australian government's Prostheses List. This means they are guaranteed a permanent place on the list. Private hospital cover from Australian health funds which include cover for prostheses must pay a benefit for an insulin pump on the Prostheses List when:

  • The pump is provided during a service for which Medicare offers a benefit.
  • The service is provided by a consultant health care professional.
  • The service is a certified Type C procedure for which hospitalisation was necessary due to your medical condition or other circumstances.

To make sure you get accurate and helpful information, this guide has been edited by Jason Loewenthal as part of our fact-checking process.

Written by

Tim Bennett

Insurance expert

A seasoned journalist with over 10 years of experience in news, politics and finance reporting, Tim has previously held roles at the ABC, SBS and Fairfax Media. Tim’s expert insights have been quoted in The Australian, The Daily Telegraph, The Courier Mail and more. He regularly appears on TV and radio, and has been interviewed on 7 News, Sunrise, SBS News, ABC Local, 3AW and 5AA. Tim is passionate about simplifying complex insurance topics for Australian consumers. He holds a Bachelor of Arts (Politics) from Macquarie University and a Tier 1 General Insurance (General Advice) certification, which meets the requirements of ASIC Regulatory Guide 146 (RG146). If you’re interested in a media interview with Tim, please reach out to our PR team at aupr@finder.com. See full bio

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