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.
Medicare Open Enrollment runs October 15 – December 7, 2026, with changes effective January 1, 2027. If you're considering a plan change, review your injection therapy coverage carefully before the December 7 deadline. Your plan's Annual Notice of Change, which Medicare Advantage and Part D plans are required to send by the end of September, spells out what will be different next year, so read it first.
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. Some plans are also moving to electronic prior authorization in 2027, so ask how requests are handled and how quickly decisions are made.
- What are the cost-sharing amounts? Compare your current plan's deductible, copay, and out-of-pocket maximum against the new plan.
If You Are Already in a Medicare Advantage Plan
If you are in a Medicare Advantage plan and miss the December 7 deadline, you get one more chance: the Medicare Advantage Open Enrollment Period, January 1 – March 31. During that window you can switch to a different Medicare Advantage plan or return to Original Medicare. It does not let you move from Original Medicare into Medicare Advantage, so it is best not to rely on it, especially if you are in the middle of a treatment series.
How We Can Help
Our billing team can review your current and prospective plan details with you. 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.
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