If you receive regular eye injections — such as anti-VEGF therapy for wet macular degeneration, diabetic macular edema, or retinal vein occlusion — open enrollment is one of the most important times of year for your eye health. Changing or losing coverage mid-treatment can disrupt your care schedule, which matters greatly for preserving vision.

Open Enrollment runs October 15 – December 7 for most Medicare plans, with changes effective January 1st. If you're considering a plan change, review your injection therapy coverage carefully before the deadline.

Why Injections Require Extra Planning

Anti-VEGF injections (such as Eylea, Lucentis, Avastin, or Vabysmo) are typically administered on a recurring schedule — sometimes monthly, sometimes every 6–16 weeks. Delays due to coverage issues can lead to vision loss that may not be recoverable. Unlike many other treatments, gaps in injection therapy carry real, measurable risk.

What to Check Before Switching Plans

• Is your medication covered? Different Part D or Medicare Advantage plans have different formularies. Confirm your specific injection drug is on the plan's drug formulary, and at what tier.
• Is Fox Valley Ophthalmology in-network? If you're considering a Medicare Advantage plan, verify that our practice is listed as an in-network provider.
• Are there prior authorization requirements? Some plans require pre-authorization for injection therapy, even if you've been receiving it for years.
• What are the cost-sharing amounts? Compare your current plan's deductible, copay, and out-of-pocket maximum against the new plan.

How We Can Help

Our billing team can review your current and prospective plan details with you. If you're comparing plans, bring the Summary of Benefits for each plan to your next visit, or call our office and we can walk through the coverage specifics with you over the phone.

The most important thing: don't let an administrative gap interrupt your treatment. Call us before open enrollment ends if you have any questions about how a plan change might affect your injection schedule.