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Understanding Health Insurance > Applying for Insurance > Insurance Considerations

Insurance Considerations

Picking an insurance plan is a big decision, so take the time to compare the different options available.

Answer the following questions to receive tailored discussion topics that you may wish to consider:

Where are you in your health insurance journey?
What scenario sounds more like you?
What scenario sounds more like you?

You want an original Medicare plan with a supplement

Here are some questions to ask yourself when reviewing a new plan.

You can bring them to your retina specialist and insurance company for extra advice.

Although these questions are specifically about your retina treatment, it's important to consider all your conditions when choosing a Medicare plan.

01.

How much does your current retina injection cost for the whole year, including coinsurance, copays, and deductibles?

02.

If you need to increase the number of retina injections in the future, how much would this cost each time?

03.

In this new plan, is your retina injection fully covered under your health insurance or do you have coinsurance?

04.

How much is the monthly premium in this new plan, and would a lower premium every month mean more costs for your medical services?

05.

How often are you getting retina injections in a year?

06.

Is your retina specialist in-network with this health insurance plan?

07.

If you’ve been recently diagnosed with a chronic retinal disease, does this plan cover the retina injection your retina specialist may prescribe?

08.

Do you need a prior authorization (PA), step therapy, or other requirements to get your retina injection approved?

09.

Does this plan cover eye exams and imaging at your retina doctor’s office?

This information is intended for educational purposes only and is not a substitute for professional insurance or medical advice. It does not cover all possible considerations and may not apply to your specific situation. It’s important to consider all your conditions when choosing a Medicare plan.

You want a Medicare Advantage plan

Here are some questions to ask yourself when reviewing a new plan.

You can bring them to your retina specialist and insurance company for extra advice. Although these questions are specifically about your retina treatment, it's important to consider all your conditions when choosing a Medicare plan.

01.

How much does your current retina injection cost for the whole year, including coinsurance, copays, and deductibles?

02.

If you need to increase the number of retina injections in the future, how much would this cost each time?

03.

In this new plan, is your retina injection fully covered under your health insurance plan or do you have coinsurance?

04.

How much is the monthly premium in this new plan, and would a lower premium every month mean more costs for your medical services?

05.

How often are you getting retina injections in a year?

06.

Is your retina specialist in-network with this health insurance plan?

07.

Does this plan require a referral from a primary care doctor before you can see a retina specialist?

08.

If you’ve been recently diagnosed with a chronic retinal disease, does this plan cover the retina injection your retina specialist may prescribe?

09.

In this new plan, do you need a prior authorization (PA), step therapy, or other requirements to get your retina injection approved?

10.

Does this plan cover eye exams and imaging at your retina doctor’s office?

This information is intended for educational purposes only and is not a substitute for professional insurance or medical advice. It does not cover all possible considerations and may not apply to your specific situation. It’s important to consider all your conditions when choosing a Medicare plan.

You’re on original Medicare and want to add a supplement

Here are some questions to ask yourself when switching to a new plan.

You can bring them to your retina specialist and insurance company for extra advice. Although these questions are specifically about your retina treatment, it's important to consider all your conditions when choosing a Medicare plan.

01.

How much does your current retina injection cost for the whole year, including coinsurance, copays, and deductibles?

02.

How much is the monthly premium in this insurance plan, and would a lower premium every month mean more costs for your medical services?

03.

Would adding a Medicare Supplemental Insurance help with out-of-pocket costs for your retina injection treatment?

04.

Which Medicare Supplement Insurance coverage helps with all of my required medical services?

05.

How often are you getting retina injection treatments in a year?

06.

Is your retina specialist in-network with this health insurance plan?

07.

If you’ve been recently diagnosed with a chronic retinal disease, does this plan cover the retina injection your retina specialist may prescribe?

08.

In this new plan, do you need a prior authorization (PA), step therapy or other requirements to get your retina injection treatment approved?

09.

Does this plan cover eye exams and imaging at your retina doctor’s office?

This information is intended for educational purposes only and is not a substitute for professional insurance or medical advice. It does not cover all possible considerations and may not apply to your specific situation. It’s important to consider all your conditions when choosing a Medicare plan.

You're on a Medicare Advantage plan and want to switch to a different plan or switch to Original Medicare

Here are some questions to ask yourself when switching to a different Medicare Advantage plan or Original Medicare and a supplement.

You can bring them to your retina specialist and insurance company for extra advice. Although these questions are specifically about your retina treatment, it's important to consider all your conditions when choosing a Medicare plan.

01.

How much does your current retina injection cost for the whole year, including coinsurance, copays, and deductibles?

02.

If you need to increase the number of retina injections in the future, how much would this cost each time?

03.

How does the plan's annual maximum out-of-pocket (MOOP) amount compare with your current plan?

04.

In this insurance plan, would you need to get Medicare Supplemental Insurance to help with out-of-pocket costs for your retina injection treatment?

05.

Would my medical services still be covered if they were pre-existing conditions?

06.

How often are you getting retina injection treatments in a year?

07.

Is your retina specialist in-network with this health insurance plan?

08.

In this new plan, do you need a prior authorization (PA), step therapy, or other requirements to get your retina injection approved?

09.

Does this plan cover eye exams and imaging at your retina doctor’s office?

This information is intended for educational purposes only and is not a substitute for professional insurance or medical advice. It does not cover all possible considerations and may not apply to your specific situation. It’s important to consider all your conditions when choosing a Medicare plan.

You’re under 65 and looking at commercial health insurance plans

Here are some questions to ask yourself when considering a commercial health insurance plan.

You can bring them to your retina specialist and insurance company for extra advice. Although these questions are specifically about your retina treatment, it's important to consider all your conditions when choosing a commercial health insurance plan.

01.

How much does your current retina injection cost for the whole year, including coinsurance, copays, and deductibles?

02.

If you need to increase the number of retina injections in the future, how much would this cost each time?

03.

Would this commercial plan fully cover your retina injection or do you have a co-pay?

04.

How does the commercial plan's annual maximum out-of-pocket (MOOP) amount compare with your current plan?

05.

Would my medical services still be covered if they were pre-existing conditions?

06.

How often are you getting retina injection treatments in a year?

07.

Is your retina specialist in-network with this health insurance plan?

08.

In this commercial insurance plan, do you need a prior authorization (PA), step therapy, or other requirements to get your retina injection approved?

09.

Does this plan cover eye exams and imaging at your retina doctor’s office?

This information is intended for educational purposes only and is not a substitute for professional insurance or medical advice. It does not cover all possible considerations and may not apply to your specific situation. It’s important to consider all your conditions when choosing a Medicare plan.

Thank you

Your request has been submitted.
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BACK TO TOP

  • You can’t buy a Supplement Insurance plan while you’re in a Medicare Advantage Plan unless you’re switching back to Original Medicare.22

  • A provider network is a list of doctors, other health care providers, and hospitals that a plan contracts with to provide medical care to its members. They’re known as “in-network providers."5,12

  • Also called out-of-pocket limit or out-of-pocket maximum, the absolute most you will have to pay out-of-pocket for covered medical services in a plan year. If you meet that amount, your health insurance plan will pay for 100% of your covered medical services for the remainder of that plan year.5,12

  • Original Medicare includes Part A (Hospital Insurance) and Part B (Medical Insurance). Original Medicare usually covers services at 80%, like inpatient hospital care, doctor's services and tests, and preventive services.1,2

  • A plan managed by commercial insurance companies that combines Part A, B & usually D. Your plan’s out-of-pocket costs may vary, and generally many plans pay 80% for Part B specialty drugs (retina injections).1,2

IMPORTANT SAFETY INFORMATION

What is VABYSMO?

VABYSMO (faricimab-svoa) is a prescription medicine given by injection into the eye used to treat adults with neovascular (wet) age‑related macular degeneration (AMD), diabetic macular edema (DME), and macular edema following retinal vein occlusion (RVO).

Do not receive VABYSMO if you:

  • Have an infection in or around your eye. 
  • Have active swelling around your eye that may include pain and redness. 
  • Are allergic to VABYSMO or any of the ingredients in VABYSMO.

What is the most important information I should know about VABYSMO?

  • Injections like the one for VABYSMO can cause an eye infection (endophthalmitis), separation of layers of the retina (retinal detachment), or inflammation in the eye that can lead to vision loss. Call your healthcare provider right away if your eye becomes red, sensitive to light, or you have a change or loss of vision.
  • VABYSMO may cause a temporary increase in pressure in the eye (intraocular pressure), which occurs within 60 minutes after receiving the eye injection.
  • Although not common, VABYSMO patients have had serious, sometimes fatal, problems related to blood clots, such as heart attacks or strokes (thromboembolic events). In clinical studies for wet AMD during the first year, 7 out of 664 patients treated with VABYSMO reported such an event. In clinical studies for DME from baseline to week 100, 64 out of 1,262 patients treated with VABYSMO reported such an event. In clinical studies for RVO during 6 months, 7 out of 641 patients treated with VABYSMO reported such an event.
  • Severe inflammation of vessels in the retina has happened for patients treated with VABYSMO. Call your healthcare provider immediately if you experience a change in vision.

Before receiving VABYSMO, tell your healthcare provider about all of your medical conditions, including if you:

  • Are pregnant or plan to become pregnant. Based on how VABYSMO interacts with your body, there may be a potential risk to your unborn baby. You should use birth control before your first injection, during your treatment with VABYSMO, and for 3 months after your last dose of VABYSMO.
  • Are breastfeeding or plan to breastfeed. It is not known if VABYSMO passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby if you receive VABYSMO.
  • Are taking any medications, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Tell your healthcare provider about all the medicines you take.

What should I avoid while receiving VABYSMO? 

  • Your vision may be impaired after receiving an eye injection or after an eye exam. Do not drive or use machinery until your vision has recovered sufficiently.

What are the most common side effects with VABYSMO?

  • The most common side effects with VABYSMO were cataract and blood on the white of the eye (conjunctival hemorrhage).
  • These are not all the possible side effects of VABYSMO.

Call your healthcare provider for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects to Genentech at 1-888-835-2555. 

Please see the VABYSMO full Prescribing Information for additional Important Safety Information.

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