Cost of insulin pump on private health cover

I’m very new to the topic of type 1 diabetes. I’m on here to learn more and understand how I can better support my brother who was just diagnosed.

Right now I’m concerned about the cost of an insulin pump and I’m wondering if anyone might know the costs of this if one has private health cover.

Welcome to TuDiabetes! I’m sorry that you have to be here and that your brother has T1D, but so impressed that you are seeking more info to support him.

Costs for insulin pumping will vary pretty widely depending on your insurance and with your terminology I’m guessing that you aren’t in the US?

Pump hardware ranges from about $5k - 7k in the US before any coverage kicks in and then you have the reservoirs and infusion sets which are typically an every 90-day expense of about $1K pre-coverage.

My out of pocket for my last pump was $300 and including the deductible, my infusion sets and reservoirs are in the $50 - 300 range.

Let us know where your brother is located and you’ll get better answers.

You will have to call the pump company sales department and have them get back to you with a price after they process a request thru your insurance. Asking others about pricing is fruitless.

I would look into a CGM - either the Dexcom, or the Freestyle Libre, depending on cost and what your insurance will cover, before bothering with a pump. A pump can be a valuable tool for some, but a CGM will make a huge difference right away and is extremely valuable whether using a pump or injections. In fact, studies are showing that people can achieve the same level of control using a CGM, with or without a pump.


Your brother needs to have a history of treatment and blood glucose control before considering a pump. If after six months or so, his treatment has maintained good control of his blood glucose, a pump would be considered inappropriate.

That’s not a universally accepted opinion…because everybody’s diabetes, goals of control, etc. are different. For my insurer, the medical policy for coverage does not disqualify people with “good control”. Whether or not to use a pump, and when to start on a pump, is something he should assess by reading up on it, talking with his doc or endo, maybe go to a CDE and look at some pumps and learn about the ins and outs.

To help the OP’s brother assess the cost of a potential pump, he has to gain some understanding of his insurance details. The ins and outs of co-pays, out of pocket max, deductibles etc. will all affect the cost. The pump manufacturers have a sales force who can deal with his insurer and get these details sorted out.

For me, I read up on pumping for a few years, went to my endo for a prescription/recommended pump model, went to a CDE to look at pumps and ask questions, “signed up” for a pump on the Insulet (Omnipod) web site. After that, Insulet had several people who were very helpful and got me all set up to start with a pump in January. They struggled a bit with the prior authorization process with my insurer but they got it all done and covered/ordered before the 2019 year end. I got my initial order of Omnipods covered in December this way because I had hit my 2019 out of pocket max and only had to spend $75 for 3 months of Onmipods plus a controller.

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A CGM would be the most important first step. A Dexcom is best because of alerts and the ability to calibrate, but if cost ends up being a factor the Libre is a lot cheaper. It saves having to do some of the finger sticking and gives you a much better picture of what your blood sugars are doing. That just makes life easier for us.

I would be tempted to say to get a good idea of carb counting and basic control before a pump is gotten. While a pump is easier management for me, it does add a whole new layer of learning, not hard, just different. And if there is a pump failure etc, it would be nice to know the basics again for the few days he might need to.

It really depends on your brothers insurance. Whether I had good or bad control made no difference in whether I qualified for it, the endo just had to send in the request as needed for my type 1 diabetes. My initial set up didn’t cost me anything for my Dexcom or my Omnipod. I am one of the lucky ones as my insurance covers everything 100% for sensors and pods. My insurance does cost me about $400 a month.

My point was not whether or not insurance would cover a pump. I was trying to point out that until you know whether your diabetes can be controlled with an inexpensive medication such as Metformin for less than $10 a month, you should not be looking to spend several hundred dollars or more on a pump. He may not even need insulin.

Metformin is not given to a new type 1 except by inexperienced GPs who are afraid to prescribe insulin. A type 1 needs to start on insulin right away. Some may use very small amounts at first due to the honeymoon, but there is strong evidence that tight control will prolong beta cell function. Also most type 1s are diagnosed at very high blood sugars which require insulin to bring down.

You would die without insulin as a type 1. You might be able to delay the use depending on how soon you are diagnosed and how long of a honeymoon period, but there is no choice of whether you need insulin.

Sorry, forgot I was in a T1 Forum. My bad.

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Hey Don, it’s not a T1 Forum, but the OP noted the diagnosis was T1D.

For some, managing T1D using MDI and/or Afrezza is a perfectly viable solution, and let’s face it a pump is generally going to be a more expensive option. Appreciate your input, always.

Personal opinion here and this is just my opinion not what everyone should or has to do.
I just feel everyone who is type 1 should do MDI initially. This way the person learns all about insulin actions and heaven forbid, if you have a pump failure you would know how to handle it.
I will also say, everyone should have a CGM prescription written with a type 1 diagnosis. Without knowledge of what is happening and how the insulin is working, this disease can be so very hard to deal with.
While I love, love my pump, you could not pull my CGM from me! And of course now with CGM and pump working together I can’t go without either.
And pumps are very expensive and work. But it give me a lot more flexibility.
Each of us has different goals, different lifestyles, different family lives. Just gotta find what works best for you at this time of your life!

To be technical, this post is under “Type 1 and LADA.” But as a T2, I still read almost everything that comes up as new or updated anyway


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