Option 1: Private Health Insurance
Private health insurers, under the Private Health Insurance Act 2007, might cover the cost of insulin pumps as part of their hospital or general treatment policies. This means, if you're admitted to the hospital and need an insulin pump, your private health insurer might pay for the cost of the pump, your hospital stay, and your doctor's fee.
However, not all cases require hospital admission. Some insurers still cover the cost of the pump in such instances, but the conditions and benefits can vary. For more detailed information, you can check out the full Prostheses List here.
Remember, the coverage level might depend on your private health insurer, with insulin pumps usually covered only under the top-tier 'Gold' level of hospital cover.
Option 2: Buy It Yourself
You also have the option to buy an insulin pump outright.
Joining the National Diabetes Services Scheme (NDSS): If you're diagnosed with diabetes, it's a good idea to register with the Australian Government's National Diabetes Services Scheme (NDSS). This scheme provides subsidised insulin pump consumables, like reservoirs and infusion sets. For more information on how to register with NDSS, click here.
Getting your insulin
You can get your insulin from pharmacies with a prescription from your GP or Endocrinologist. The Pharmaceutical Benefits Scheme (PBS) covers a significant portion of the cost through Medicare, and a prescription usually lasts 3-6 months, depending on your insulin needs.
Medtronic Bridging the Gap Program:
Medtronic offers a program called Bridging the Gap to support your diabetes management. If you qualify, you'll get access to a Medtronic insulin pump while you're waiting for your health fund to kick in, for up to 12 months.
Who can apply?
To be eligible, you must:
- Have private hospital cover that includes insulin pumps
- Be in the 12-month waiting period for private health cover benefits
- Have been diagnosed with Insulin Dependent diabetes
- Meet the NDSS criteria for insulin pump consumables
- Be under supervision from healthcare professionals, including a diabetes educator and endocrinologist or paediatrician, for insulin pump therapy
What About the Ongoing Costs?
You'll need to buy infusion sets and reservoirs for your pump, but these are available from the NDSS through Diabetes Australia for around $25-$30 per month, as long as you meet the criteria. Before sending off your application, make sure it's signed and completed, and check with your state Diabetes Australia office to order your consumables.
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