What is a Medicare Broker?

April 21, 2021

Independent Medicare Insurance Brokers – Who are they and what is it going to cost me?

At Crawford Benefits, we are Medicare insurance brokers. We are appointed with all major Medicare carriers so that we can give you unbiased advice on your Medicare plan options. As your agent, we will review all of the options available and recommend a plan that most closely fits your individual needs and budget. 


What’s the benefit of using Crawford Benefits as your Medicare insurance broker?

Crawford Benefits provides personal back-end policy support that you do not get directly from an insurance company. Instead of you gaining frustration on the phone with insurance carriers and automated systems, we make the calls to help you with very common Medicare hiccups which can be otherwise stressful for you.

We help our clients daily with billing errors, Medicare appeals, solving pharmacy exceptions when they can’t get their medication, file claims, and so much more. We can interpret communications that you receive from Medicare or your carrier if you have questions. While every situation is different and we can’t guarantee outcomes, we are able to resolve many issues and offer policy assistance to our clients every day. 

We also often provide simple and easy education to you about how Medicare works. Every year, thousands of Medicare beneficiaries feel frustrated after trying to read the Medicare handbook. At Crawford Benefits, we will educate you by breaking Medicare down into pieces that are easier to understand. 


What is the cost of using a Medicare insurance agent?

The good news is in most cases we are paid by the carriers to service your plan*. You pay exactly the same rate for your insurance if you use us as your Medicare consultant/broker. This means in most cases, you pay ABSOLUTELY NOTHING for our help. Because we are contracted with all the major carriers, we are not incentivized by commissions, but focus solely on meeting the needs of our clients.

*We do reserve the right to obtain a minimal consulting fee in the event an insurance carrier will not compensate our agents. If we foresee this situation, our clients are informed of this fee prior to meeting with us.


Where is Crawford Benefits located and how can I make an appointment?

Crawford Benefits is an established agency operating at 2223 Brookstone Centre Parkway, Suite A, Columbus, Georgia 31904. We have two active agents as well as a support staff. We operate Monday – Friday and are accessible via phone, email, or in person. Our top priority is you, our client. We protect our time and our client base by not over-extending in order to give you the personal attention you deserve. Our agents know and care about our clients. We learn about your personal experience, your families, and your needs. When you choose Crawford Benefits as your Medicare agent, you will have someone by your side every step of the way not only during enrollment periods, but year-round. We would love the opportunity to meet you in person or over the phone. You can schedule a consultation on our website or by calling 706-257-5073. We look forward to partnering with you for your future insurance needs. 


Oh, and we love referrals!

How Life Events Can Qualify You for Special Enrollment

January 23, 2026
Health insurance enrollment is not always limited to a single time of year. While Open Enrollment is the most widely known opportunity to sign up for or change health coverage, many people are surprised to learn that certain life changes can allow them to enroll outside of that window. These opportunities are called Special Enrollment Periods, often referred to as SEPs. If you experience a qualifying life event, you may be able to enroll in a new health insurance plan or make changes to your existing coverage without waiting for Open Enrollment. Understanding how Special Enrollment works can help you avoid gaps in coverage, unexpected medical bills, and unnecessary stress during major life transitions. What Is a Special Enrollment Period? A Special Enrollment Period is a limited timeframe that allows you to enroll in or modify your health insurance coverage after experiencing a qualifying life event. For individual health insurance, this window lasts 60 days from the date of the event, although most group (employer) plans allow a shorter period of 30 days. During a Special Enrollment Period, you may be able to apply for a new health plan, switch plans, add or remove dependents, or adjust your coverage to better match your new circumstances. If you miss this window, you may have to wait until the next Open Enrollment period to make changes, which could leave you uninsured or underinsured for months. Acting promptly is key. Common Life Events That Qualify for Special Enrollment Several major life changes can make you eligible for a Special Enrollment Period. One of the most common qualifying events is loss of credible health coverage. This can include losing employer-sponsored insurance, aging off a parent’s plan at age 26, or losing eligibility for Medicaid or CHIP. When coverage ends unexpectedly, a Special Enrollment Period allows you to replace it without waiting until Open Enrollment. Changes in household status are another common qualifying category. Events such as getting married, getting divorced, having a baby, adopting a child, or having a child placed in foster care can all trigger Special Enrollment. These life events often significantly change healthcare needs and costs, making it important to update your coverage as soon as possible. A change in residence can also qualify you for Special Enrollment, especially if the move gives you access to new health insurance plans. Moving to a new state or county, relocating for work or school, or returning to the U.S. after living abroad may all make you eligible. However, simply moving within the same area without access to new plans may not qualify, so it’s important to understand the details. Income Changes and Special Enrollment Income changes can also play a role in Special Enrollment eligibility, particularly for those who purchase coverage through the Health Insurance Marketplace. If your income decreases, you may become eligible for premium tax credits or cost-sharing reductions that make coverage more affordable. In some cases, a significant income change can open a Special Enrollment Period. On the other hand, an increase in income may affect your current financial assistance and require plan updates to avoid owing money back at tax time. Reporting income changes promptly helps ensure you are enrolled in the correct plan and receiving the appropriate level of financial support. What Does Not Qualify as a Life Event? Not every change in your life qualifies for a Special Enrollment Period. Simply deciding whether you want a different health insurance plan or missing the Open Enrollment deadline does not trigger eligibility. Voluntarily canceling your coverage without another qualifying reason may also leave you uninsured until the next Open Enrollment period. Because Special Enrollment eligibility depends on specific criteria, understanding which events qualify and providing proper documentation is essential. Assuming eligibility without confirmation can lead to delays or denied applications. How to Use Your Special Enrollment Period If you experience a qualifying life event, the first step is to gather any required documentation. This may include proof of loss of coverage, a marriage certificate, birth or adoption records, or proof of a change in address. These documents are often required to verify your eligibility. Working with a licensed health insurance professional can simplify the process. An experienced advisor can help you understand your options, ensure deadlines are met, and guide you toward a plan that fits both your healthcare needs and your budget. Don’t Wait to Protect Your Coverage Life changes can happen quickly and unexpectedly but losing health insurance does not have to add to the stress. Knowing how Special Enrollment works gives you the confidence to take action when it matters most. If you believe you have experienced a qualifying life event, it is best to explore your options as soon as possible to avoid coverage gaps. Having the right health insurance at the right time provides peace of mind, financial protection, and access to the care you need. That peace of mind is something everyone deserves.

What’s Changing in 2026: Key Updates

October 10, 2025
Individual / ACA Marketplace Plans 1. Premiums Are Rising Sharply Insurers in many states are proposing increases in ACA marketplace premiums of 10–27% for 2026. Some preliminary data show a median premium increase around 18% nationwide. 2. Out-of-Pocket Maximums & Deductibles Increasing With healthcare costs and inflation, government rules are pushing up the limits: what you pay in deductibles, copays, and the most you’ll ever pay in a year is going up. For many ACA-compliant plans, the maximum out-of-pocket is moving significantly higher in 2026. 3. Subsidies (Premium Tax Credits) Might Shrink Enhanced premium tax credits that have helped many people afford marketplace plans are set to expire at the end of 2025 unless extended by Congress. When they expire, many people will see their net premiums (what you pay after subsidies) increase—possibly by a large margin. 4. Eligibility Rules and Participation Changes There may also be changes in who qualifies for what levels of help, and how much. Household income, size, and even your recent medical needs could affect the cost and availability of plans more than before. Medicare 1. Part B & Part D Premiums and Cost Sharing Are Increasing Medicare Part B monthly premiums and Part D premiums are projected to go up in 2026. For example, the base beneficiary premium for Part D is expected to increase about 6%, while Part B premium increases are more significant. 2. Out-of-Pocket Drug Caps Go Up The maximum out-of-pocket cost for prescription drugs under Medicare Part D will increase: from $2,000 in 2025 to $2,100 in 2026. 3. Medicare Prescription Payment Plan (MPPP) Changes The MPPP, which helps you spread prescription drug costs across the year rather than paying full cost at the counter every time, will auto-renew unless you opt out. Also, plan sponsors must process opt-outs within three days. 4. Updates to Medicare Advantage (MA), Part D, Dual-Eligible Plans (D-SNPs), and Star Ratings CMS’s 2026 final rule introduces nuanced changes in how plans are rated, how prescription drug benefits are structured, and enhancements/modifications for Dual Eligible Special Needs Plans. Why These Changes Matter for You These are not just abstract policy shifts — they can affect your wallet, your coverage, your access to care, and how much protection you really have. Here’s why reviewing your coverage matters: • Costs Could Go Up Significantly With premiums, out-of-pocket maximums, and deductibles rising, what seemed affordable last year may look very different in 2026. If you rely on subsidies for ACA plans, those shrinking could be a big hit. • Your Health Situation May Have Changed If your health needs have changed (new medications, more frequent doctor visits, upcoming surgeries, etc.), the plan you had before may no longer serve you well. A plan that seemed adequate might now expose you to large costs. • Benefit Designs Differ Widely Even within Medicare Advantage, Part D, and ACA plans, plan features vary: prescription drug formularies, preferred providers, prior-authorization rules, network coverage, and perks are not uniform. A review helps you match plan features to your actual needs (doctors you use, medications, specialists, etc.). • Avoid Gaps, Surprises, & Administrative Issues Auto-renewals or changes might happen that you miss. For instance, with MPPP auto-renewing, you might stay in a plan whose new cost structure works less well for you. Provider directories may change. If you don’t check, you could discover after the fact that your usual doctor isn’t in-network. • Opportunity to Optimize With change comes opportunity. You may find a cheaper plan, more subsidy, or better coverage that suits your situation. You might re-evaluate whether a high-deductible plan with HSA works, or perhaps a more robust Part D plan is worth the premium. A consult helps you see those trade-offs and make an informed decision. What to Ask / Look at During Your Consult or Review When you sit down to review, whether with a licensed agent, broker, or counselor, here are items you’ll want to cover: Projected total costs: premiums + deductibles + drug costs + copays + out-of-pocket maximums Changes to subsidies / tax-credits for ACA plans Plan networks: are your doctors / hospitals included? Drug formularies: are your prescription drugs covered? Are there shifts in prior authorization? Extra benefits (vision, dental, hearing, wellness perks) and trade-offs for those extras Whether your Medicare Advantage plan or Original Medicare plus a supplement better serves you, given new MA changes Timing: open enrollment periods, deadlines, required paperwork for subsidies, verification of income, etc. Conclusion: Why You Should Act Now Given all the changes ahead in 2026, waiting to review can leave you exposed: to cost increases you didn’t anticipate, to being “locked in” to a plan that no longer fits, or missing out on new benefits. Booking a consult / review now gives you lead time to: Understand what changes will hit you Adjust your budget or savings to cover increases Shop smartly and compare alternatives before open enrollment ends Make sure paperwork is in order so you don’t lose subsidies or coverage Give us a call at 706-257-5073 to schedule your 2026 consult now!