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January 31, 2008

Insulin Pumps, Insurance/Costs

Question from Ft. Myers, Florida, USA:

I was diagnosed with type 1 diabetes when I was eight years old. I have kept my blood sugar levels within normal range when growing up. As I age, I find that my blood sugar levels are out of control at times. I am working in the restaurant industry and would like to know all about insulin pumps. I have searched the Internet and have found out much, however, at the present time, I do not have insurance and am seeking Medicaid to assist me with my diabetic supplies. Would you happen to know if I could receive an insulin pump if I qualify for Medicaid? I have inquired about having insurance, but my premiums are much too high for the wage that I earn. Also, due to having a pre-existing condition, many insurance companies will not issue me a policy, I need HELP and I feel that I need it now. Would you be able to assist me with the knowledge that I have given you? I would like to learn the names of the companies that manufacture insulin pumps so I can ask if any of those companies offer any assistance to people like me.


From: DTeam Staff

Medicaid eligibility depends on several issues: age, number of dependents, income and assets/resources (cars, home, savings). As for coverage of insulin pumps and supplies, Florida Medicaid will pay for an insulin pump if it meets the program’s medical necessity protocol. The first step after obtaining coverage through Medicaid is to seek medical care from a physician. That physician will evaluate if an insulin pump is a recommended therapy. Then, the Medicaid program will evaluate the recommendation for initiation of pump therapy. Information concerning the manufacturers of insulin pumps can be obtained found of our page on Insulin Pump Therapy. One can also seek assistance through the Partnership for Prescription Assistance.

In my humble opinion, an individual should not consider beginning insulin pump therapy unless they have reliable resources to purchase, or access to, the supplies needed to maintain the treatment regimen. There is a finite number of pumps donated by the medical device industry. When an individual obtains a donated pump, but abandons therapy after realizing they cannot afford the daily supplies, that pump is not available in the hands of another person in need who is committed and has the resources to fully utilize the donated pump.