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). 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. It can be potentially life saving for people 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) provides fully subsidised insulin pumps to people under 21 with type 1 diabetes who meet its clinical and financial tests: a combined annual household income of $123,078 or less, no access to a pump through private health insurance, and Medicare eligibility. Diabetes Australia has administered the program on behalf of the Australian Government since August 2026. Applications open in rounds and were closed when we last checked in September 2026, so anyone outside the program may need 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.

Because they aren't available under Medicare, insulin pumps aren't as common in Australia as in other countries. Diabetes Australia has argued that Medicare should fully fund insulin pumps for more Australians, so that access isn't limited to people who can afford private health insurance.

How does private health insurance cover insulin pumps?

All gold-tier hospital policies are required to cover insulin pumps and finding the best one will come down to your own personal needs. 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 health 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 is 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 pregnant 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 Insulin Pump Program provides fully subsidised insulin pumps to eligible children and young adults under 21 with type 1 diabetes whose combined annual household income is $123,078 or less. Applications open in rounds, so check with Diabetes Australia, which administers the program, for the current round. The NDSS also 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 on the Australian government's Prescribed List of Medical Devices and Human Tissue Products, which was called the Prostheses List until it was renamed on 1 July 2023. Being listed isn't permanent: the Department of Health, Disability and Ageing updates the list around 3 times a year and runs post-listing reviews. Private hospital cover from Australian health funds which include cover for prostheses must pay a benefit for an insulin pump on the Prescribed 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.

• What is the typical cost of an insulin pump in Australia without private health insurance?

  Without private health insurance, an insulin pump typically costs between $5,000 and $10,000 to purchase outright. Alternatively, some models can be leased at around $2,000 per year. The total price can vary depending on the specific type of pump, its features, and the specialist you choose.

• Are insulin pump consumables and supplies covered by health insurance or government schemes?

  While private hospital insurance may cover the insulin pump itself, consumables like reservoirs and infusion sets are generally not included in hospital cover. However, the National Diabetes Services Scheme (NDSS) offers a subsidy for insulin pump consumables for eligible individuals with type 1 diabetes, significantly reducing the out-of-pocket cost from their typical price range of $20-$32. Some extras health insurance policies may also provide benefits for diabetes consumables like blood glucose monitoring devices and test strips.

• What is the difference between 'diabetes management' cover and 'insulin pump' cover in Australian health insurance?

  In Australia, the 'diabetes management' clinical category in hospital cover explicitly excludes insulin pumps. Insulin pumps fall under an entirely separate category, which is a minimum requirement for Gold-tier policies. This means that a basic 'diabetes management' policy (e.g., Bronze tier) will cover general diabetes care in hospital but will not cover an insulin pump; you need a Gold or specific Silver Plus policy that includes the dedicated insulin pump category.

• What waiting periods apply for private health insurance cover for insulin pumps?

  Typically, a 2-month waiting period applies for general hospitalisation benefits that might include an insulin pump. However, if your diabetes is classified as a pre-existing condition, a longer 12-month waiting period will generally apply before you can claim benefits for an insulin pump through your private health insurance policy.

• Can private health insurance cover an insulin pump if I'm not admitted to hospital?

  Although insulin pumps are primarily listed under hospital cover, some health insurers may offer a benefit towards the cost of your insulin pump even if you are not admitted to hospital for its provision. This particular benefit varies between health funds and specific policies. It is essential to carefully review your policy documents, including the Product Disclosure Statement (PDS), or directly contact your insurer to confirm your specific out-of-hospital coverage before obtaining an insulin pump.

• What are the key eligibility criteria or conditions for claiming an insulin pump through private health insurance?

  To claim an insulin pump through private health insurance, you generally need to hold an eligible Hospital Cover product (typically Gold or some Silver Plus policies) that specifically includes insulin pumps, and you must have completed the necessary waiting periods. Health funds often require a request form from a diabetes educator and a referral letter from your treating endocrinologist. Additionally, the insulin pump must be deemed clinically necessary for the member and be listed on the Department of Health, Disability and Ageing's Prescribed List of Medical Devices and Human Tissue Products (formerly the Prostheses List). Benefits are usually payable if the service forms part of a hospital inpatient admission, though some funds may offer benefits for out-of-hospital provision.

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

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