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However, Medicare still covers visits to your doctor, other treatments to help with diabetes and several treatments for chronic kidney failure, including dialysis.
Some treatments you might expect to be in the Insulin Pumps clinical category are under different clinical categories. For example, treatment for:
stabilisation of hypo- or hyper- glycaemia is under Diabetes Management (not included on the MBS)
liposuction to correct contouring after multiple insulin injections is under Diabetes Management.
Which Hospital Cover tiers include Insulin Pumps?
Tier
Clinical category covered?
Can insurers offer restricted cover?
Basic
Optional
Yes
Bronze
Optional
No
Silver
Optional
No
Gold
Yes
No
What does it mean if cover is ‘optional’?
‘Optional’ means that the Australian government allows insurers to choose whether or not to cover the clinical category under that Hospital Cover tier.
What does ‘restricted cover’ mean?
Restricted cover means the insurer pays only limited benefits.
If insurers offer cover for Insulin Pumps under Basic Hospital Cover, they can do so on a ‘restricted’ basis. If you are admitted as a private patient in a private hospital for treatments under this clinical category, you will face considerable out-of-pocket costs.
Always check with your insurer before agreeing to be treated as a private patient in a private hospital if you have restricted cover for Insulin Pumps.
Does Medicare cover Insulin Pumps?
No. Medicare does notcover any treatments or devices under the Insulin Pumps clinical category.
However, Medicare pays for doctor visits and one treatment under Diabetes Management.
