Insulin pump cost
Expert tips for taking out the right health insurance
Our health insurance expert, Steven Spicer, has some valuable tips for choosing health insurance.
Steven Spicer
Executive General Manager – Health, Life & Energy
Choose the right level of cover
When looking at different policies, you may wonder how to know what level of cover is right for you. Consider if you have specific needs (like an insulin pump), your family history and health care services you use regularly. These details are a great starting point for deciding which inclusions you need and which cover is unnecessary for you.
Make sure you understand your inclusions
When looking into health insurance, it’s essential to know what inclusions your policy has and what those inclusions actually cover. For example, insulin pumps have their own separate clinical category and are not covered by ‘diabetes management’. Understanding precisely what your policy covers will help you avoid being caught out when you need it most.
Compare your policy regularly
Our health needs change over time and it’s important to keep your health insurance up to date to ensure you’re covered for what’s important to you. Regularly checking your policy allows you to track your inclusions, weigh up what you still need and remove cover you no longer require. Alternatively, you may decide that you need to upgrade your level of cover, which you can do at any time. Just keep in mind that you will need to serve any relevant waiting periods before claiming.
What is an insulin pump?
An insulin pump is a battery-operated electronic device designed for insulin delivery and as an alternative to multiple daily injections.1 The device is worn externally, though it can be hidden under clothing. An insulin-filled reservoir is attached to your body through a cannula inserted under the skin and infusion set. The pump is programmed to be controlled by the pump user. If glucose levels are too high, extra insulin can be delivered. The pump is designed to be worn 24 hours a day, but it can be taken off for brief intervals for activities such as swimming, showering, sex and sports.
Benefits of an insulin pump
There are many potential benefits to having an insulin pump, including:1
- Greater glucose control
- More flexibility with mealtimes and lifestyle
- Decreased likelihood of hypoglycaemia
- The option for continuous glucose monitoring (CGMS)
- Improved management during exercise and sickness
- Can be safer during pregnancy as insulin needs vary a lot during this time.
For the right patients, insulin pumps can significantly improve their quality of life. Like any medical treatment, there are a few potential downsides to insulin pumps, including:1
- Because insulin pumps only use rapid-acting insulin, any disruption to insulin delivery for a few hours can raise blood glucose levels quickly
- Some patients struggle with the technology
- There is a chance of skin infections
- Without a CGMS, patients need to monitor their blood levels frequently.
Like most treatments, an insulin pump won’t be the right solution for everyone. Talk to your healthcare team or diabetes educator about your condition and what the best treatment plan might be.
What is the cost of an insulin pump in Australia?
The pump without health insurance usually costs $5,000-$10,000 to purchase outright, or $2,000 per year.2 Insulin pump consumables and infusion sets usually cost between $20 and $30.90, but the NDSS will subsidise this price for those with type 1 diabetes (provided they meet all eligibility criteria). There are a few factors that will influence the price of getting an insulin pump, including:
- The type of insulin pump
- Any extra features
- Your choice of specialist
- Whether or not you’re receiving a subsidy/have health insurance.
Does private health insurance cover the cost of an insulin pump?
Private hospital insurance can contribute towards the costs of insulin pumps, providing your policy offers the applicable inclusions. The level of cover required can vary between insurers and policies.
It’s important to understand that the ‘diabetes management’ clinical category in hospital cover explicitly excludes insulin pumps; insulin pumps are under an entirely separate category which is only a minimum requirement for Gold-tier policies. Depending on your health fund, you may be able to have insulin pumps included in a lower tier as part of a Plus policy.
Though listed as hospital cover, some health insurers will still pay a benefit towards the cost of your insulin pump without you needing to be admitted into the hospital. This varies between health funds, so you should read your policy documents, including the Product Disclosure Statement (PDS) and the Target Market Determination (TMD), to understand your cover better and ensure the policy is suitable. If you’re unsure, always check before having your insulin pump fitted to ensure you’re covered.
What is the National Diabetes Services Scheme?
The National Diabetes Services Scheme (NDSS) is an Australian Government initiative to provide diabetes care to Australians. The purpose is to both help those with diabetes to understand their condition and provide necessary support services and help subsidise necessary diabetes technology and products, including:
- Insulin pump consumables
- Syringes and needles
- Urine test strips
- Continuous glucose monitoring (CGM) products.
The NDSS also offers a subsidy on Omnipod DASH® pods. However, this is only available to those with type 1 diabetes.
Registration with the NDSS is free for eligible individuals and can be done through their website. Eligibility details can also be found on the NDSS website.
Is there a waiting period for insulin pump claims?
When you take out health insurance, you’ll need to serve a waiting period before making a claim. The standard waiting period for insulin pumps is two months. The exception to this is if you had a pre-existing condition before taking out health insurance; for example, if you had been diagnosed with diabetes before purchasing a policy with an insulin pump cover. For pre-existing conditions, there is a 12-month waiting period. These are standard waiting periods across health funds in Australia.
Meet our health insurance expert, Steven Spicer
As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.
Want to learn more about health insurance?
1 Baker Heart & Diabetes Institution – All About Insulin Pumps. Accessed November 2024
2 Diabetes Victoria – Tips to cut your diabetes costs. Accessed November 2024.
3 NDSS: Nation Diabetes Services Scheme – Insulin pump consumables. Accessed November 2024