Insulin Pump Coverage: Navigating Costs and Insurance for Type 2 Diabetes

Managing type 2 diabetes (T2D) often comes with the challenge of navigating insulin pump coverage. From understanding costs to dealing with Medicare and insurance policies, figuring out how to access an insulin pump can feel overwhelming. But with the right knowledge and resources, these devices can simplify diabetes care and improve your quality of life.

But getting access to insulin pumps isn’t always easy.

Some barriers include:

• The belief that pumps are only for people with type 1 diabetes (T1D).
• Healthcare providers are not suggesting them.
• Insurance coverage issues.

“I think the biggest barrier is that people with T2D think pumps are just for kids or people with T1D,” says Julia Blanchette, Ph.D., RN, CDCES. “It’s important for clinicians to bring up these options and help patients work with insurance to get what they need. I always encourage education on self-management tools, like carb counting, before starting a pump to ensure success.”

Are insulin pumps covered for people with type 2 diabetes?

One of the toughest parts of getting an insulin pump is the cost.

Without insurance, pumps can cost thousands of dollars—not including monthly supplies. However, many people with T2D can get partial or full coverage through health insurance. Coverage depends on your plan, but most pumps are covered under:

• Durable medical equipment (DME): This category includes items like crutches and braces. If pumps are covered as DME, your supplies come from the manufacturer or a third-party supplier. Costs depend on your insurance plan and pump brand.
• Pharmacy benefit: Some insurance plans cover pump supplies through pharmacy benefits. This often lowers out-of-pocket costs compared to DME. Co-pays are usually fixed monthly fees. Supplies can be delivered or picked up from a pharmacy.

Medicare and Medicaid coverage

Medicare now covers pumps, supplies, and insulin under Medicare Part B for people with T2D who meet specific conditions. Insulet’s Omnipod is covered under Medicare Part D. For Medicaid, coverage varies by state, so it’s best to contact your state’s Medicaid office directly.

Tips for getting an insulin pump

Getting an insulin pump takes some effort, but here are tips to make the process smoother:

• Research brands: Check out options like Insulet (Omnipod), Medtronic, and Tandem to find the best fit. Omnipod is the only tubeless pump available.
• Benefits check: Work with the manufacturer or your doctor to see how much your insurance will cover. Coverage may vary depending on the pump brand’s agreement with insurers.
• DME vs. pharmacy benefit: Ask your insurance which coverage applies to your pump supplies. Insulet’s Omnipod is more likely to be covered under pharmacy benefit, while others are usually under DME.
• Medicare questions: If you’re on Medicare, ask whether your pump is covered under Part B or Part D. Most pumps fall under Part B, but Omnipod is covered under Part D.
• Advocate for coverage: If you’re denied, ask your healthcare team to explain why pump therapy is better for you than multiple daily injections (MDI). Reasons could include fewer emergencies, better blood sugar control, and improved quality of life.

Insulin pumps can give you freedom from injections and make it easier to manage diabetes. With the right education and advocacy, you can find the pump that works for you.