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The Big Insurance Lie: Why your small business is probably overpaying for “peace of mind” (and how to stop)

Ed MacConnell

Let’s have a straight-talk conversation. If you are a small business owner, you’ve probably been told that the "safest" way to handle employee benefits is to sign up for a traditional, fully-insured plan from one of the big-name carriers, pay your monthly premium, and put the whole headache out of your mind. They call it "peace of mind." At Total Benefit Solutions Inc, we call it the "Big Insurance Lie." The truth is, many small businesses are overpaying for their health coverage by anywhere from 15% to a staggering 80%. When you consider that health insurance is often the second largest expense on a balance sheet after payroll, that "peace… Read More

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MVP vs. MEC: The Compliance Difference That Could Cost You Thousands

Ed MacConnell

If you’ve been following our blog recently, you know we’ve been diving deep into the world of Minimum Value Plans (MVP). We’ve talked about compliance and why your plan needs to actually meet these standards. But here is where things usually get messy for HR managers and business owners: the alphabet soup of the ACA. Specifically, the difference between MEC (Minimum Essential Coverage) and MVP (Minimum Value Plan). To the untrained eye, they sound like the same thing. They both start with "Minimum," they both deal with health insurance, and they both keep the IRS off your back, right? Not exactly. Confusing these two isn't just a minor clerical error;… Read More

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Medicare Secondary Payer Rules: A Quick-Start Guide for Employers with 65+ Staff

Ed MacConnell

As we move further into 2026, the landscape of the American workforce continues to shift. More than ever, we are seeing valued team members choose to work well past the traditional retirement age of 65. While having that experience and institutional knowledge on your team is a massive win for your business, it does introduce a specific layer of complexity regarding your employee benefits strategy. The biggest question we get here at Total Benefit Solutions Inc is often some variation of: "My top salesperson just turned 65. Do they have to go on Medicare, and who pays their medical bills first?" The answer lies within the Medicare Secondary Payer (MSP)… Read More

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A new Special Enrollment Period has been created allowing select beneficiaries in Pennsylvania to shop for coverage until April 30

Lily Dalton

A new Special Enrollment Period (SEP) has been opened for certain Pennsylvania UnitedHealthcare Medicare Advantage beneficiaries, allowing them to shop for new coverage through April 30 due to a contract dispute with Lehigh Valley Health Network that eliminated in-network access for affected members as of January 26, 2026. This SEP is separate from the standard Medicare Advantage Open Enrollment Period, which ends March 31. Last week, the Shapiro Administration announced an SEP for UnitedHealthcare Medicare Advantage beneficiaries using Lehigh Valley Health Network Providers. This SEP is a result of contract disputes between Lehigh Valley Health Network and UnitedHealthcare. As of January 26, 2026, over 5,400 UnitedHealthcare Medicare Advantage members lost in-network access… Read More

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HRAs Growing for Small Businesses

Lily Dalton

Health Reimbursement Arrangements (HRAs) are becoming an increasingly popular option for small businesses looking to provide affordable healthcare benefits. These employer-funded accounts allow companies to contribute tax-free dollars that employees can use to cover qualified medical expenses or purchase individual health insurance. There are several types of HRAs available, including the General HRA, which works alongside group insurance to cover out-of-pocket costs like co-pays, dental, and vision; the Individual Coverage HRA (ICHRA), which reimburses employees for insurance they purchase on their own; and the Qualified Small Employer HRA (QSEHRA), designed specifically for businesses with fewer than 50 employees that do not offer group plans. One of the main advantages of… Read More

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ACA Employer Mandate penalties are the highest ever

Ed MacConnell

ACA Employer Mandate penalties are the highest they have been since passage of the ACA. Here is a quick refresher for appliable large employers (or those close to hitting the 50 FTE threshold) on determining ALE status and tracking hours of its employees.

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Medicare Secondary Payer Rules: 7 Mistakes Employers Are Making (And the CMS Penalties You Can’t Ignore in 2026)

Ed MacConnell

If you're an employer with 20 or more employees, you need to understand Medicare Secondary Payer rules, because CMS isn't asking nicely anymore. 2026 is shaping up to be a major enforcement year. CMS is tightening scrutiny on employers who mess up Medicare coordination, and the penalties aren't slaps on the wrist. We're talking mandatory reimbursements to Medicare, civil money penalties, and potential lawsuits that can drain your budget faster than any premium increase. The problem? Most employers have no idea they're even at risk until CMS comes knocking. At Total Benefit Solutions, we fight these battles every day, pushing back when carriers get the rules wrong, advocating when employers… Read More

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Dental Plans 101: What Every Mid-Sized Employer Needs to Know for 2026

Ed MacConnell

If you're managing benefits for a company with 50-200 employees, dental insurance is probably on your radar: but it might be lower on your priority list than medical coverage. That's a mistake. Here's the reality: dental benefits are one of the most used (and most appreciated) employee benefits you can offer. Employees actually see their dentist twice a year for cleanings, and when they need a filling or root canal, they're reminded exactly how much value that dental plan provides. At Total Benefit Solutions, we've seen firsthand how the right dental plan can boost retention, keep your team healthy, and avoid the nightmare scenario of someone calling out for a… Read More

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The Tooth Truth: How Preventive Dental Plans Save Your Company Thousands in the Long Run

Ed MacConnell

If you're a mid-sized employer shopping for affordable group health insurance, you've probably been told that dental coverage is a "nice-to-have" add-on. That's dead wrong. At Total Benefit Solutions, we've spent three decades proving that preventive dental plans aren't just employee perks, they're one of the smartest cost-containment strategies you can deploy. The data is clear: employers who invest in strong preventive dental benefits save thousands per employee over time, reduce absenteeism, and stop hemorrhaging money on emergency procedures that should never have happened in the first place. Here's why we push every client to take dental seriously, and how the numbers prove we're right. The Guardian Life Study: The… Read More

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More Than Just a Smile: Why Dental Insurance is a Retention Powerhouse for Small Businesses

Ed MacConnell

If you're running a small business and watching your best employees walk out the door for "better benefits," there's a good chance you're missing one of the simplest retention tools in the book: dental insurance. I know what you're thinking. "Ed, we're a small shop. We can barely afford medical insurance. How are we supposed to add dental?" That's exactly the conversation I have with business owners every week, and here's what I tell them: You can't afford NOT to offer it. At Total Benefit Solutions, we don't accept the tired excuses carriers and administrators throw at small businesses. We fight for affordable group health insurance packages that actually work,… Read More

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The ‘Hidden’ Health Benefit: How Dental Coverage Catches Major Medical Issues Early

Ed MacConnell

Here's something most small business owners don't realize when they're cutting costs on group health benefits: dental coverage isn't just about preventing cavities. It's one of the most effective early warning systems for serious medical conditions like diabetes, heart disease, and oral cancer. At Total Benefit Solutions, we've spent three decades fighting for employers who deserve better than "bare minimum" benefits packages. And we've learned that dental insurance isn't a "nice-to-have" perk: it's a strategic health investment that catches expensive medical problems before they explode your claims and sideline your workforce. Why Your Dentist Sees More Than Your Doctor Does The average American visits their dentist twice a year but… Read More

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Why We Never Let Carriers Say ‘No’ to Necessary Dental Surgery

Ed MacConnell

Picture this: One of your employees gets a diagnosis, jaw tumor, severe infection requiring hospitalization, or a traumatic injury that shatters three teeth and damages the bone. The oral surgeon says surgery is medically necessary. Your employee submits the claim. And then the insurance carrier sends back a denial letter with some version of "dental procedures aren't covered under your medical plan." At Total Benefit Solutions, that's where the real work begins. Because we don't accept "no" when "no" means your employee is stuck with a $15,000 bill for a surgery that should have been covered. The Dental Coverage Shell Game Insurance carriers have perfected the art of passing the… Read More

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Reference Based Pricing Explained in Under 3 Minutes (Is It Right for Your Group?)

Ed MacConnell

Let's cut through the noise. Reference based pricing (RBP) is exactly what it sounds like: you pay healthcare providers based on a reference point: typically a percentage above Medicare rates: instead of whatever inflated number a traditional PPO network negotiates (or doesn't negotiate). It's not for everyone. But if you're tired of watching premiums climb 8-12% every year while carriers shrug and say "that's just how it is," RBP might be the shake-up your group needs. How Reference Based Pricing Actually Works Here's the traditional PPO model: insurance carriers negotiate "discounts" with provider networks. A hospital charges $50,000 for a surgery. The carrier "negotiates" it down to $40,000 and calls… Read More

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The Secret to Getting a Health Insurance Refund: Is Level Funding Right for You?

Ed MacConnell

Here's something most small business owners don't know: there's a type of group health insurance for employers that can actually write you a check at the end of the year. Not a bill. A refund. Sounds too good to be true, right? But it's not some gimmick or marketing trick. It's called level funding, and it's one of the smartest moves a small to mid-sized business can make when traditional health insurance premiums keep climbing year after year. Let me explain how this works, and whether your business should be taking advantage of it. What Is Level Funding (And Why Don't More People Know About It)? Level funding sits right… Read More

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Stop Overpaying for Health Insurance: The Small Business Guide to Level Funded Plans

Ed MacConnell

Let's be real: traditional group health insurance for employers feels like you're throwing money into a black hole every year. Premiums keep climbing (hello, 2026 rate increases), you have zero visibility into where your dollars are actually going, and you're basically betting that your insurance carrier knows your business better than you do. Spoiler alert: they don't. If you're tired of watching your health insurance costs spiral while getting nothing but vague explanations from your carrier, it's time to look at level funding. It's the insurance model that gives small business owners what they've been begging for: transparency, control, and the possibility of actually getting money back at the end… Read More

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Level Funding in 2026: What Your Business Needs to Know About Compliance and Costs

Ed MacConnell

If you're a small to mid-sized business owner looking at your 2026 health insurance renewal and feeling that familiar sinking feeling in your stomach, you're not alone. Traditional fully insured premiums are climbing yet again, and many employers are searching for alternatives that won't break the bank. Enter level funding, a hybrid approach that's gaining serious traction among businesses with 10-100 employees. But here's the thing: level funding isn't just about lower monthly payments. It comes with its own set of compliance obligations that you absolutely need to understand before making the switch. What Is Level Funding, Anyway? Think of level funding as the "Goldilocks" option for group health insurance… Read More

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Level Funding 101: How Small Businesses Can Beat Rising Insurance Premiums

Ed MacConnell

If you're a small business owner, you've probably noticed that your group health insurance for employers keeps getting more expensive every year. The 2026 renewals are already showing premium increases that'll make your accountant cringe. But here's something most business owners don't know: you're not stuck choosing between sky-high premiums and dropping coverage altogether. Level funding is the middle ground that's been saving small businesses thousands of dollars: and it's time more employers knew about it. What Exactly Is Level Funding? Think of level funding as the "Goldilocks" of health insurance. It's not fully insured (where you pay fixed premiums and the insurance company takes all the risk), and it's… Read More

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Medicare Secondary Payer Rules Explained in Under 3 Minutes

Ed MacConnell

If you're an employer with Medicare-eligible employees on your group health plan : or you're an employee trying to figure out whether to drop your employer coverage once you hit 65 : you need to understand Medicare Secondary Payer (MSP) rules. These rules determine which insurance pays first when someone has both Medicare and employer-sponsored coverage. Get it wrong, and you could face claim denials, surprise bills, or even compliance penalties. Let's break it down in plain English. What Are Medicare Secondary Payer Rules? Medicare Secondary Payer rules determine the order in which insurance plans pay when someone has both Medicare and other coverage (like group health insurance from an… Read More

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Lost Your Job? Here's Your Complete Guide to Health Insurance Options (COBRA vs ACA vs Medicaid Compared)

Ed MacConnell

Losing your job hits hard enough without worrying about losing your health insurance too. The good news? You've got options, and we're going to walk through every single one so you can make the smartest choice for your situation. Here's the reality: You have 60 days from your last day of coverage to make a decision. That might seem like plenty of time, but trust me: these 60 days fly by when you're dealing with job searches, unemployment paperwork, and everything else that comes with a career transition. The three main paths forward are COBRA (continuing your old employer's plan), ACA Marketplace plans (buying individual coverage), and Medicaid (government assistance… Read More

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7 Mistakes You're Making with Group Health Insurance Costs (and How to Fix Them)

Ed MacConnell

Let's be real: group health insurance for employers isn't cheap. And if you're running a small or mid-sized business, every dollar counts. The frustrating part? Many business owners are overspending on their group health benefits without even realizing it. The good news is that most of these costly mistakes are completely fixable. You just need to know what to look for. We've helped countless employers find affordable group health insurance that actually works for their teams and their budgets. Along the way, we've spotted the same mistakes popping up again and again. Here are the seven biggest ones: and exactly how to fix them. Mistake #1: Choosing a Plan Based… Read More

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Medicare Secondary Payer Rules Explained: Your Quick-Start Guide to 2026 Compliance

Ed MacConnell

If you're an employer offering group health benefits, or an employee trying to figure out how your coverage works alongside Medicare, the Medicare Secondary Payer (MSP) rules are something you absolutely need to understand. And with 2026 shaping up to be a major enforcement year, now's the time to get your compliance ducks in a row. Let's break down what the medicare secondary payer rules actually mean, when Medicare pays second, and what you need to do to stay on the right side of the regulations this year. What Are Medicare Secondary Payer Rules? Here's the deal: Medicare doesn't always pay first for your healthcare costs. In certain situations, another… Read More

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