The 2027 Open Enrollment Patchwork: Tracking Deadlines in PA, NJ, and AZ

Ed MacConnell

If you feel like the rules for health insurance are changing faster than the seasons, you aren’t alone. For the 2027 plan year, we have witnessed a significant "regulatory whiplash" that has left many individuals and business owners scrambling to update their calendars. At Total Benefit Solutions Inc, we have been tracking these developments closely to ensure our clients are never caught off guard by a shifting deadline. The headlines for the upcoming 2027 Open Enrollment (OE) season have been dominated by a legal tug-of-war. What was originally planned as a shortened, more restrictive enrollment period has been largely overturned by a recent lawsuit. This means that for many of… Read More

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The ‘I’m Too Young for Insurance’ Tax: What Happens When You Skip Coverage

Ed MacConnell

Let’s be real for a second. You’re 26, 28, maybe 32. You’re finally finding your rhythm as a freelancer or gig worker. You hit the gym three times a week, you drink your greens, and the last time you saw a doctor was for a physical three years ago. When you look at your monthly budget, that $300 or $400 health insurance premium feels like a total scam. It’s money disappearing into a black hole for a "what if" that feels a lifetime away. So, you decide to "go naked" (industry speak for uninsured). You figure you’ll just pay out of pocket if you get a cold. But here’s the… Read More

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ACA Controlled Group Penalties: What Happens When the IRS Finds Out You’re an ALE

Ed MacConnell

You manage your business with precision. You know your payroll numbers, your overhead, and your staff count. You have 35 full-time employees, which, in your mind, keeps you safely under the 50-employee threshold for the Affordable Care Act (ACA) Employer Mandate. You aren't an "Applicable Large Employer" (ALE), so you don't think you need to worry about offering group health insurance for employers or filing complex IRS forms. But what if you also own 85% of a secondary boutique firm with 20 employees? Or what if you and your two business partners own three different LLCs, each with 18 employees? Suddenly, the IRS doesn't see three small businesses. They see… Read More

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Pennie’s 2027 Open Enrollment Shift: You Just Got More Time (But Don’t Waste It)

Ed MacConnell

If you have been keeping a close eye on the calendar for your 2027 health insurance planning, you probably noticed some conflicting information recently. For months, the buzz around Pennsylvania’s state-based exchange, Pennie, suggested that the Open Enrollment window was going to be significantly shorter than in previous years. However, we have some major news that will change how you approach your year-end planning. Pennie has officially reverted to its original, extended Open Enrollment dates. While many expected a condensed window, you now have until mid-January to finalize your coverage for the 2027 plan year. At Total Benefit Solutions Inc, we make it our mission to stay on top of… Read More

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Do You Own Multiple Businesses? The ACA Controlled Group Trap That Could Cost You

Ed MacConnell

If you’re an entrepreneur with your hands in several different pots, you probably feel like you’ve mastered the art of the "small" business. You might own a local restaurant, a residential cleaning company, and a boutique retail shop. In your mind, these are three separate entities with three separate payrolls. Because each business employs fewer than 50 people, you likely believe you are exempt from the Affordable Care Act (ACA) employer mandate. You might think that group health insurance for employers is a choice, not a requirement, for your specific situation. However, there is a technicality in the tax code that the IRS uses to "aggregate" your employees across all… Read More

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What Happens to Your Health Insurance When You Quit Your W-2 for a Gig?

Ed MacConnell

The moment you hand in your notice to your boss, you feel a rush of freedom. No more mandatory 9-to-5, no more "reply-all" emails, and no more asking for permission to take a Tuesday afternoon off. You’re becoming your own boss: a gig worker, a freelancer, or a sole proprietor. But then, the realization hits: you just quit your health insurance, too. In the W-2 world, insurance is often "invisible." It's a deduction on your paycheck that you rarely think about until you need a doctor. In the gig world, health insurance is an active business decision. If you don't handle the transition correctly within your first 60 days, you… Read More

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You Probably Didn’t Know Your HRA Costs You $3.84 per Employee, Here’s the Deal

Ed MacConnell

If you’re a business owner, you’re used to the usual suspects when it comes to costs: payroll, rent, and the rising price of health insurance. But there’s a sneaky little fee hiding in your Health Reimbursement Arrangement (HRA) that many employers completely miss until it’s almost too late. It’s called the PCORI fee (Patient-Centered Outcomes Research Institute fee). While the name sounds like something out of a medical textbook, the reality is much simpler: it’s a federal fee that helps fund research for the government, and if you offer an HRA, you’re likely on the hook for it. Currently, that fee is ticking up. Depending on when your plan year… Read More

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The New NJ Medicaid Employer ‘Tax’: Is Your Business Ready for the Per-Person Fee?

Ed MacConnell

If you are a business owner in New Jersey, the legislative landscape just shifted beneath your feet. On Tuesday night, June 30, Governor Mikie Sherrill signed a piece of legislation that moved through Trenton with remarkable speed. As part of the FY27 budget package, Assembly Bill A5324 (and its Senate counterpart S4533) officially established a new "Employer Health Care Contribution Assessment." At Total Benefit Solutions Inc, we don't believe in sugarcoating regulatory changes. This is essentially a new "Medicaid Tax" on employers whose workers rely on state-funded health insurance. While the state aims to raise approximately $145 million to offset Medicaid costs, the administrative and financial burden on New Jersey… Read More

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PCORI Fee Deadline Looming? We’ll Break Down Who Pays, When, and How

Ed MacConnell

If you are an employer providing health benefits to your team, you likely already know that the summer months bring more than just heatwaves and vacation requests. For many business owners and HR managers, the end of July marks a critical compliance deadline that often flies under the radar: the Patient-Centered Outcomes Research Institute (PCORI) fee. While it might sound like just another acronym in the alphabet soup of the Affordable Care Act (ACA), the PCORI fee is a mandatory federal excise tax that requires your attention. If you are handling a self-insured plan or a Health Reimbursement Arrangement (HRA), missing this deadline isn't just a minor oversight, it’s a… Read More

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The Quiet Death of the PPO: What Small Businesses Need to Know About 2026 Plans

Ed MacConnell

For years, the Preferred Provider Organization (PPO) was the undisputed gold standard for small business health insurance. If you were a business owner who wanted to recruit and retain the best talent, you offered a PPO. It sent a clear message to your employees: "We trust you to manage your own health, and we’re giving you the freedom to see any doctor, anywhere." But as we look toward the 2026 plan year, that gold standard is starting to show some serious rust. In fact, if you look closely at the filings and the carrier trends, the traditional broad-network PPO is undergoing a "quiet death." Carriers are slowly but surely phasing… Read More

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PCORI Fee Due July 31: Small Biz Owners, Don’t Forget This Hidden Tax on Your HRA

Ed MacConnell

If you are a small business owner offering health benefits, you likely feel like you’ve finally mastered the basics. You’ve picked a plan, you’re managing premiums, and your team is covered. But then, a cryptic acronym like "PCORI" pops up on your radar, accompanied by an IRS deadline. The Patient-Centered Outcomes Research Institute (PCORI) fee is one of those "hidden" requirements from the Affordable Care Act (ACA). While it might seem like a small administrative hurdle, missing the July 31 deadline can lead to unnecessary headaches with the IRS. If you manage a Health Reimbursement Arrangement (HRA) or an Individual Coverage HRA (ICHRA), the responsibility for this fee falls squarely… Read More

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New Options for the Self-Employed: Ameristead Health Plans Now Available Through Total Benefit Solutions

Ed MacConnell

For many years, self-employed professionals, gig workers, and small business owners have faced a significant challenge in the health insurance market. If you aren't part of a large corporation with thousands of employees, finding a high-quality, comprehensive health plan that doesn't break the bank can feel like an impossible task. You often find yourself stuck between expensive individual plans on the ACA (Affordable Care Act) Marketplace or "short-term" plans that might not offer the long-term protection you actually need. At Total Benefit Solutions Inc, we have always committed ourselves to finding better ways for our clients to navigate these complexities. We are thrilled to announce a new partnership that addresses… Read More

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Gen Z Is Quietly Ditching Their Benefits (And Most Brokers Have No Idea)

Ed MacConnell

If you are a business owner or an HR leader, you likely spent a significant portion of your budget last year on an employee benefits package. You probably assumed that by offering a robust health plan, you were checking a major box in your retention strategy. However, there is a growing trend that is flying under the radar of most traditional insurance brokers: Gen Z is quietly opting out. As we move through 2026, data reveals a stark disconnect. While marketplace enrollment is hitting record highs across the general population, a substantial number of younger workers (those born between 1997 and 2012) are skipping employer-sponsored coverage entirely or failing to… Read More

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What Is a Controlled Group Under the ACA? (And Why Your Brother-Sister Business Might Be an ALE)

Ed MacConnell

You’ve worked hard to build your business empire. Maybe you started with a small consulting firm, then branched out into a separate LLC for property management, and perhaps even a third venture in retail. On paper, each of these businesses has fewer than 20 employees. You might think you’re safely tucked under the 50-employee threshold for the Affordable Care Act (ACA) employer mandate. But there’s a "hidden" rule that catches many entrepreneurs off guard: the Controlled Group regulation. Under the ACA, the IRS doesn't just look at each of your businesses in a vacuum. If they are connected through common ownership or control, they are treated as a single employer.… Read More

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Can AI Stop You From Picking the Wrong Health Plan?

Ed MacConnell

Open Enrollment is often the most stressful time of the year for both employers and employees. It is a period defined by dense paperwork, confusing jargon, and the high-stakes pressure of choosing the right safety net for the next twelve months. Despite the annual ritual, we aren't getting any better at it. Recent industry data reveals a staggering reality: 35% of employees regret their health insurance choices once the enrollment window closes. (This "regret factor" often stems from realizing a preferred doctor is out-of-network or that out-of-pocket costs are higher than anticipated.) As we move into 2026, many businesses are looking to Artificial Intelligence (AI) to solve this problem. If… Read More

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The Medicare GLP-1 Bridge: What It Is, Who Qualifies, and the $50 Catch Your Clients Will Miss

Ed MacConnell

As we approach July 1, 2026, a major shift is coming to the world of Medicare prescription drug coverage. For years, beneficiaries have struggled with the high costs of weight-loss medications, often finding themselves stuck between "medical necessity" and "cosmetic exclusion" rules. That changes, temporarily, with the launch of the Medicare GLP-1 Bridge. This time-limited demonstration program from the Centers for Medicare & Medicaid Services (CMS) is designed to provide a pathway for eligible seniors to access life-changing weight-management medications without the typical financial hurdles. At Total Benefit Solutions Inc, we know that navigating these new "demonstrations" can feel like learning a second language. That is why we are breaking… Read More

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2027 HSA Limits Are Here: What You Need to Know About New Contribution, Deductible & Out-of-Pocket Caps

Ed MacConnell

The Internal Revenue Service (IRS) has officially released the inflation-adjusted limits for Health Savings Accounts (HSAs) and High Deductible Health Plans (HDHPs) for the 2027 calendar year. These updates, detailed in Revenue Procedure 2026-24, reflect the ongoing economic shifts and provide individuals and employers with the necessary benchmarks to plan their benefits strategy for the upcoming year. At Total Benefit Solutions Inc, we know that navigating the nuances of IRS regulations can feel like a full-time job. Whether you are a small business owner looking to optimize your employee benefits package or an individual trying to maximize your tax-advantaged savings, understanding these new caps is the first step toward financial… Read More

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Medicare Secondary Payer Rules: 15 Things You Need to Know to Avoid Penalties

Ed MacConnell

Let’s be honest: talking about Medicare Secondary Payer (MSP) rules is about as exciting as watching paint dry, unless, of course, that paint is actually a fine from the federal government. For small business owners and HR managers, these rules are the "hidden traps" of the health insurance world. One wrong move, and suddenly your "affordable group health insurance" plan is facing claw-backs, penalties, and a very grumpy group of employees. At Total Benefit Solutions Inc, we spend our days navigating these bureaucratic mazes so you don’t have to. We’re the advocates who never take "no" for an answer, especially when it comes to protecting your business from avoidable compliance… Read More

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Stephanie Spancake Total Benefit Solutions Inc

Beyond Sick Leave: Integrating HRAs and Group Health

Ed MacConnell

Beyond Sick Leave: Integrating HRAs and Group Health Managing mandatory sick leave is just one piece of the employee retention puzzle. At Total Benefit Solutions Inc, we believe in a holistic approach. If you’re already paying for mandatory sick leave, you might be looking for ways to balance your budget elsewhere without sacrificing the quality of your benefits. This is where Health Reimbursement Arrangements (HRAs) come into play. HRAs allow employers to reimburse employees for medical expenses (and sometimes premiums) tax-free. They are an excellent tool for small to mid-sized businesses navigating the PA sick leave patchwork. HRA Plan Design Options for 2026: Section 105 HRA (For 1 Employee or… Read More

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Medicare Secondary Payer Rules: 15 Things You Need to Know to Avoid Penalties.

Ed MacConnell

Let’s be honest: talking about Medicare Secondary Payer (MSP) rules is about as exciting as watching paint dry, if that paint were also trying to fine you thousands of dollars. But if you’re a small business owner or an HR manager, ignoring these rules is like playing a high-stakes game of poker where the dealer is the federal government and they’ve already seen your hand. Medicare is a bit like that friend who always "forgets" their wallet when the check comes. They’re happy to help, but only after everyone else has chipped in first. Knowing when Medicare pays first (primary) and when they pay second (secondary) isn’t just a matter… Read More

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The Driver’s Dilemma: Why You’re Not ‘Stuck’ Without Health Insurance (Even If You’re 1099)

Ed MacConnell

Meet Sal. Sal has been driving for Uber and Lyft in the Philadelphia area for three years. He loves the flexibility, being his own boss means he never misses his daughter’s soccer games. But there’s one thing that keeps Sal up at night: the "Driver’s Dilemma." As a 1099 independent contractor, Sal doesn’t have an HR department. He doesn’t have a benefits package waiting for him in an app menu. For a long time, Sal believed he was "stuck" either paying full price for a plan that cost more than his car payment or crossing his fingers and hoping he didn’t get sick. If you’re a driver, delivery person, or… Read More

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Hoop-Jumping for Health: The New ACA Rules Coming in 2027

Ed MacConnell

Just when you thought you had a handle on your health insurance, the rules are changing again. If you’ve been following the news lately, you might have heard that the Centers for Medicare & Medicaid Services (CMS) is rolling out some significant updates for the ACA Marketplace (the federal exchange where you buy individual health plans). These changes aren't hitting the ground until plan year 2027, but at Total Benefit Solutions Inc, we believe in staying ahead of the curve. While these new rules are designed to protect you from fraud and unauthorized plan switches, they do add a few more "hoops" for you to jump through during the enrollment… Read More

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The $110-a-Day Mistake: Why Your Insurance Certificate Isn’t Enough

Ed MacConnell

If you are a small business owner offering group health insurance for employers, you likely take pride in providing benefits that protect your team. You probably have a folder, digital or physical, filled with shiny brochures from your insurance carrier, a "Certificate of Coverage," and perhaps a Summary of Benefits and Coverage (SBC). You might think, "I have my documents. I’m compliant." Unfortunately, that belief is a common misconception that could cost your business thousands of dollars. In the world of federal regulation, there is a massive gap between what the insurance company provides and what the law requires you, the employer, to provide. This gap is known as the… Read More

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