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Health insurance for insulin pumps
Health insurance for insulin pumps is compulsory for gold-tier policies, which cost around $241 a month. However, there are cheaper policies that will cover you – compare top brands below.
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*Prices updated July 2024, in line with Finder's database of health insurance policies. Prices reflect the cheapest available for a single individual with less than $97,000 income and living in Sydney with a $750 excess.
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Compare health insurance with cover for insulin pumps
Below are some hospital policies from Finder partners that cover insulin pumps and diabetes managmenent. All have a 12-month waiting period for pre-existing conditions and a 2-month waiting period if not.
How does private health insurance cover insulin pumps?
All gold-level hospital policies are required to cover insulin pumps. The Private Health Insurance Act 2007 says private health funds can cover the cost of insulin pumps under either hospital cover or general (extras) treatment cover.
Hospital
While you will need hospital cover that includes insulin pumps, many health funds, such as Medibank, ahm and Teachers Health, often do not require a hospital stay for you to receive benefits.
However, if you aren't receiving treatment in a hospital, you typically won't be covered for any facility or doctor's fees. (If you are hospitalised due to diabetes, you will be covered for hospital accommodation fees and doctor's fees in a private facility.)
Insurers can cover you for a replacement insulin pump but only after a set period of time – for example, after 4 or 5 years.
Insulin pumps are on the Prostheses List. This means hospital insurance will usually cover costs up to the specified benefit amount. This ranges from around $8,077 to $8,574.
Extras
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.
Other diabetes-related conditions
Typically, treatment for diabetes-related conditions will be covered under the body system that's affected. For example, treatment for diabetes-related eye conditions is covered by the clinical category eye. There is also a clinical catergory called diabetes management. This is covered by all bronze-tier policies. It can pay for hospital treatment for the investigation and management of diabetes. For example, if you have contour problems due to insulin injections.
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.
Type 1 diabetes is a hereditary auto-immune condition that accounts for 1 in 10 Australian diabetics. Also known as insulin-dependent diabetes, type 1 diabetes sees the body attack insulin-producing cells in the pancreas. Symptoms include:
Excessive thirst
Excessive urination
Unexplained weight loss
Fatigue and weakness
Blurred vision
Skipping a meal or exercising heavily can also cause the patient's blood sugar levels to fall, which can lead to hypoglycaemia.
Type 1 diabetes is typically diagnosed before the age of 30 and those with the condition require insulin injections in order to effectively process glucose. While there is no cure for type 1 diabetes, it can be managed with insulin injections as well as proper diet and exercise.
Type 2 diabetes
Type 2 diabetes is a much more common condition in Australia, representing up to 90% of all cases of diabetes. Also referred to as non-insulin-dependent diabetes, it is a progressive auto-immune condition that occurs as the body stops responding to the effects of insulin. This means carbohydrates and sugars are not properly metabolised and the condition usually occurs in adults over 45 years of age.
Obesity, insufficient exercise and poor diet are all contributing factors to the onset of type 2 diabetes, but there is currently no cure for the condition. Many people with type 2 diabetes have no symptoms, but some symptoms to keep an eye out for include:
Excessive thirst and urination
Feeling tired and lethargic
Feeling hungry all the time
Dizziness and mood swings
Blurred vision
Itching and skin infections
Gradually putting on weight
Leg cramps
Type 2 diabetes can be managed with healthy eating, regular exercise and sometimes medication.
Gestational diabetes
Gestational diabetes is diabetes that occurs during pregnancy. It affects 5–10% of pregnant women but usually goes away once the baby has been born.
A woman's likelihood of developing gestational diabetes is influenced by a range of factors, including a family history of type 2 diabetes, being overweight and being from certain ethnic backgrounds.
Gestational diabetes can be managed through healthy eating, regular exercise and monitoring your blood glucose levels. Most women with gestational diabetes have a normal pregnancy and a healthy baby, but if the condition is not properly managed it can lead to a large baby, miscarriage or stillbirth.
Once the pregnancy is over, blood glucose levels return to normal and gestational diabetes disappears, but women who suffer from the condition have an increased risk of developing type 2 diabetes later in life.
Prediabetes
Prediabetes refers to a condition where the body has higher-than-normal blood glucose levels, although not high enough for you to be diagnosed with full diabetes. While prediabetes does not have any signs or symptoms, sufferers are more likely to develop type 2 diabetes or cardiovascular disease later in life. Treatment involves sustained lifestyle changes, including regular exercise and healthy eating.
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Frequently asked questions
Yes, all bronze-tier health insurance policies must cover diabetes management and all gold-tier policies must cover insulin pumps.
Some extras policies can help pay for diabetic consumbales but this isn't very common. However, the NDSS subsidises costs for these types of products including syringes, blood glucose test strips, sensors and insulin pump consumables. For instance, if you use a continous glucose sensor that costs around $100 a fortnight through the supplier, the NDSS subsidy will lower costs to around $33.
If you have a health care card, many of these products will be free.
Insulin pumps are covered on all gold-tier private health insurance policies 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.
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.
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.
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.
Gary Ross Hunter was an editor at Finder, specialising in insurance. He’s been writing about life, travel, home, car, pet and health insurance for over 6 years and regularly appears as an insurance expert in publications including The Sydney Morning Herald, The Guardian and news.com.au. Gary holds a Kaplan Tier 2 General Advice General Insurance certification which meets the requirements of ASIC Regulatory Guide 146 (RG146). See full bio
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You pay nothing. Finder is free to use. And you pay the same as going direct. No markups, no hidden fees.
You save time. We spend 100s of hours researching health insurance so you can sort the gold from the junk faster.
You can trust us. We say it like it is. We aren't owned by an insurer and our opinions are our own.
