If you or a loved one receive retina injections such as Vabysmo, Eylea HD, Eylea, Izervay, or Iluvien, it’s important to understand how your Medicare coverage choices during Open Enrollment can significantly affect your out-of-pocket costs in 2025.
What is Medicare Open Enrollment?
Medicare Open Enrollment is the annual period when you can review and change your Medicare coverage. During this time, you can:
– Switch between Original Medicare and Medicare Advantage
– Enroll in or change your Part D drug plan
– Consider adding or changing a Medigap (Supplemental) plan
2025-2026 Open Enrollment Dates
| Date | Event |
| October 1, 2025 | Start reviewing your current Medicare plans |
| October 15, 2025 | Medicare Open Enrollment begins |
| December 7, 2025 | Medicare Open Enrollment ends |
| January 1, 2026 | New health plan coverage starts |
Patients with Medicaid or receiving Extra Help may be able to change drug coverage monthly starting in 2025.
Why This Matters for Retina Patients
Retina patients often rely on high-cost, name-brand medications administered in the clinic. The cost for drugs such as: Vabysmo, Eylea HD / Eylea, Izervay, Iluvien and others can vary depending on whether your plan covers the drug, how it’s billed, and whether your deductible has been met.
Questions to Ask During Enrollment
Use these prompts to guide your decision-making:
– Does my plan cover Part B medications like retina injections?
– What will I owe per injection or per visit?
– Is there a deductible I must meet first?
– What is my co-pay or co-insurance percentage?
– What is my maximum out-of-pocket limit for the year?
Medigap vs. Medicare Advantage: Know the Difference
– Medigap plans help cover costs not paid by Original Medicare (like 20% co-insurance), but not all are available to new enrollees.
– Medicare Advantage plans may have lower premiums but often come with higher co-pays, network restrictions, or prior authorization.
Medigap Plan Comparison – Selected Benefits (2025)
| Benefit | Plan G | Plan N | Plan K | Plan L |
| Part A Deductible | ✓ | ✓ | 50% | 75% |
| Part B Coinsurance | ✓ | ✓* | 50% | 75% |
| Excess Charges (Part B) | ✓ | ✗ | ✗ | ✗ |
| Foreign Travel Emergency | 80% | 80% | ✗ | ✗ |
| Out-of-Pocket Limit | N/A | N/A | $7,220 | $3,610 |
* Plan N may require copays for some office and ER visits.
Planning Tip
If you had high out-of-pocket expenses in 2024 for eye injections, don’t assume 2025 costs will be the same — plans change every year. Reviewing your plan is especially important if:
– You’re switching medications
– You’re starting retina treatment
– You’re moving between Medicare Advantage and Original Medicare
Where to Get Help
– Visit: www.Medicare.gov
– Contact your local SHINE counselor
– Ask your retina provider’s office for a benefits check. Call Longwood Eye & LASIK at 855-286-2020 extension 4.
Disclaimer: This content is provided for educational purposes only. Longwood Eye & LASIK does not endorse or recommend any specific Medicare Advantage or Medigap plan. Patients are encouraged to speak with a licensed insurance advisor or visit www.Medicare.gov for plan comparisons.
