Are Group Health Plan Rules Quietly Changing? 10 Signs Your Small Business Strategy Is Behind

Ed MacConnellNo Comments

If your business is planning for 2027 by waiting for the next renewal letter, your benefits strategy may already be behind. The rules are not changing in one single sweeping event. Instead, employers are facing a shifting combination of higher medical costs, prescription drug pressure, evolving affordability thresholds, state-by-state requirements, network changes, and greater employee expectations. One national analysis of 2027 small-group rate filings found a median proposed premium increase of approximately 14%, although actual increases will vary by carrier, state, group size, plan design, and final regulatory approval. That makes comparison more important than ever. Here are 10 warning signs that your small business health plan strategy needs a… Read More

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The Small Business Group Health Crisis: Why MEWAs (Multiple Employer Welfare Arrangements) Are Making a Comeback

Ed MacConnellNo Comments

If you own or manage a small or mid-sized business, health insurance renewal season can feel like a yearly negotiation with no good answers. A carrier’s proposed increase may be 15%–30% as an example of the market pressure many employers experience: not a universal outcome: and even a smaller increase can create difficult choices. Do you absorb the additional cost? Pass more of it to employees? Increase deductibles and copayments? Or reduce the richness of the plan until the benefit is no longer competitive? For employers in Pennsylvania, New Jersey, Arizona, and other states, traditional fully insured coverage remains an important option. However, it is not the only strategy worth… Read More

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IRS Letter 5698: What It Is, Why It Matters, and What Happens If You Ignore It

Ed MacConnellNo Comments

If your business recently received IRS Letter 5698, your first instinct might be to panic or assume you are facing an immediate tax penalty. Take a deep breath. Letter 5698 is not a penalty notice on its own. Instead, it is an official warning, a final yellow light from the Internal Revenue Service regarding your Affordable Care Act (ACA) information reporting. For Applicable Large Employers (ALEs), generally businesses with 50 or more full-time employees, including full-time equivalents, navigating ACA compliance under Internal Revenue Code Sections 6056 and 4980H is complex. When Forms 1094-C and 1095-C are missing, late, or flagged for discrepancies, the IRS initiates an outreach sequence. Letter 5698… Read More

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How to Prepare for 2027 Small Business Health Insurance Premium Increases

Ed MacConnellNo Comments

If your small or midsized business renews health coverage in 2027, waiting for the carrier’s final renewal packet could leave you with too little time to respond. Preliminary filings reported by KFF on August 6, 2026, show that nearly 300 small-group insurers across all 50 states and the District of Columbia proposed a median premium increase of 14% for 2027. That is a market signal: not a guaranteed increase for every employer. Final rates will vary by state, carrier, plan, group size, claims experience, provider contracts, and regulatory review. The business decision is bigger than whether to accept or reject a percentage. You need to determine how your coverage strategy… Read More

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4 Employee Benefit Trends to Watch in 2026: What Employers Need to Know

Ed MacConnell

As you prepare your organization for the year ahead, navigating the employee benefits landscape requires more than just renewing last year’s policies. In 2026, human resources leaders and business owners face a complex intersection of surging pharmaceutical costs, rising employee expectations, and groundbreaking technological shifts. At Total Benefit Solutions Inc., we act as dedicated independent advocates (helping businesses and individuals decode complex healthcare regulations and secure maximum value). To stay competitive and protect your bottom line, you must understand how these forces are reshaping the workplace. Here are four critical employee benefit trends to watch in 2026 and what they mean for your strategy. 1. Pharmacy Cost Pressures Demand Integrated,… Read More

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The $25,000 Fine You Didn’t See Coming: Medicare Secondary Payer Compliance for Small Employers

Ed MacConnell

You’ve built your business from the ground up. You know your profit margins, your inventory, and your team. But there is a silent regulatory landmine that many small business owners walk over every single day: Medicare Secondary Payer (MSP) compliance. It often starts with a well-intentioned conversation. An employee turns 65 and asks, "Hey, can I just drop the company health plan and go on Medicare? Maybe the company could just pay for my Medicare Part B or a Medigap policy instead?" On the surface, it sounds like a win-win. The employee gets Medicare, and you save money on their group premium. But saying "yes" to that request could trigger… Read More

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Medicare Plan N in 2026: What Retirees Need to Know Before Choosing Coverage for 2027

Ed MacConnell

Updated August 22, 2026 If you are reviewing Medicare coverage in 2026 and preparing for 2027, Medicare Supplement Plan N deserves a closer look. It can provide meaningful protection alongside Original Medicare, but it is not designed to eliminate every cost or every coverage concern. The right choice depends on more than the monthly premium. You should also evaluate how often you use medical care, whether your doctors accept Medicare assignment, how much cost-sharing you can comfortably manage, where you travel, and whether you need separate prescription drug coverage. At Total Benefit Solutions, we help individuals compare Medicare Supplement plans, Medicare Advantage, and prescription drug coverage based on their actual… Read More

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ICHRA Explained: A Smarter Way for Employers to Rethink Health Benefits

Ed MacConnell

  Health insurance is one of the most important benefits you offer: and one of the most difficult expenses to predict. Traditional group health plans can provide valuable coverage, but premiums, renewals, participation requirements, network limitations, and multistate administration can create challenges for employers. Employees may also have different doctors, prescriptions, family situations, and coverage priorities. An Individual Coverage Health Reimbursement Arrangement (ICHRA) gives employers another way to approach health benefits. Instead of selecting one group plan for everyone, an employer provides a defined contribution that eligible employees can use to purchase individual health insurance or, when properly structured, pay eligible Medicare premiums. An ICHRA can be a powerful strategy.… Read More

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Maryland PFML Private Plans: Why the September 1 Filing Window Matters for Employers

Ed MacConnell

Maryland’s Paid Family and Medical Leave program: administered through the Family and Medical Leave Insurance (FAMLI) Division: is moving toward implementation. For employers, one of the most important near-term decisions is whether to participate in the State Plan or evaluate an approved Equivalent Private Insurance Plan (EPIP). The first deadline is approaching quickly: the Declaration of Intent (DOI) filing window opens September 1, 2026, and closes November 15, 2026. If you are considering a private plan, waiting until September to begin may leave too little time to compare options, gather documentation, coordinate with a licensed insurance professional, and complete the Maryland process accurately. The DOI is the first required step… Read More

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Is Your Insurance Carrier Hiding Money? The Blue Cross Lawsuit Every Employer Needs to Know About

Ed MacConnell

For years, the health insurance industry has operated behind a veil of complexity that would make a magician blush. But a massive legal bombshell was recently dropped that suggests some of that "complexity" might actually be a cover for something far more calculated: hidden profits at the expense of American employers. A high-stakes class-action lawsuit has been filed against Blue Cross Blue Shield of Texas (BCBSTX), and it’s a case that every business owner, HR director, and CFO needs to pay attention to right now. This isn't just another legal squabble over paperwork; it’s a direct challenge to how insurance carriers handle your money, specifically, the massive "hidden" rebates they… Read More

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Why Your HR Team Will Love Remodel Health (And Why We Chose Them)

Ed MacConnell

For years, we’ve watched human resources managers and business owners dread "The Renewal." You know the feeling: that thick envelope arrives from your carrier, usually containing a 15% or 20% rate increase, and you’re left with two bad choices. You either pass the cost onto your employees or you slash benefits to keep the budget under control. It is a losing game that leaves everyone frustrated. At Total Benefit Solutions Inc., we believe there is a better way to do business. We’ve always been committed to never accepting "no" as an answer (a core philosophy we call our advocacy approach) and that means searching for tools that actually solve the… Read More

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Group of One, Real Coverage: What Sole Proprietors Are Missing in 2026

Ed MacConnell

If you are a freelancer, consultant, independent contractor, gig worker, or sole proprietor, health insurance can feel like a business problem with only one answer: buy an individual ACA plan and hope it fits. That assumption is understandable: but incomplete. Your coverage options depend on more than whether you work for yourself. They also depend on your business structure, whether you have common-law employees (workers you control and pay as employees), your state’s insurance rules, your household income, your prescriptions, your dependents, and whether you plan to hire. In 2026, the right strategy is not simply finding the lowest monthly premium. It is comparing your total exposure: premiums, deductibles, out-of-pocket… Read More

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Is Your Health Insurance Plan Stuck in the 90s? Meet the Modern Solution

Ed MacConnell

If you are still managing your company’s health insurance using a traditional "one-size-fits-all" group plan, you might as well be using a dial-up modem to run your business. The world has changed, but for many small to medium-sized businesses (SMBs), the way they buy health insurance is stuck in a different era. You know the routine. Every year, you receive a renewal notice with a double-digit price increase, and you’re forced to choose between higher premiums or worse coverage for your team. It is a cycle of frustration that leaves you with a predictable budget (predictably high, that is) and leaves your employees with a plan they didn't choose and… Read More

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Total Benefit Solutions Inc. Partners with Remodel Health: A New Era of Health Benefit Advocacy

Ed MacConnell

At Total Benefit Solutions Inc., we have spent decades serving as a lighthouse in the often-foggy world of health insurance. Our mission has always been simple: to act as your tireless advocate, navigating the complex rules of state and federal programs to ensure you get the benefits you deserve. We’ve built our reputation on a personalized approach and a refusal to ever accept "no" as an answer when fighting for our clients. Today, we are thrilled to announce a significant evolution in our ability to serve you. Total Benefit Solutions Inc. has officially entered into an agreement to represent Remodel Health, a pioneer in modern health benefit technology. By becoming… Read More

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You Can’t Enroll in October , But Your Health Problems Don’t Wait Either

Ed MacConnell

It’s a Tuesday morning in mid-October. You’ve finally found a moment to sit down and tackle that "to-do" list that’s been staring you in the face for months. At the very top, circled in red, are the words: "Sort out health insurance." You head over to the official sites, maybe click around a few marketplace portals, and then you see it, the digital equivalent of a "Closed" sign. The bold text informs you that Open Enrollment doesn't actually begin until November 1st, and even then, your coverage won't start until January 1st. A cold knot forms in your stomach. You’re a freelancer, a gig worker, or a small business owner.… Read More

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Can an ICHRA Be Used to Pay Medicare Premiums? What Employers Need to Know

Ed MacConnell

As an employer or business owner, designing a competitive health benefits package while accommodating employees of varying ages can feel like walking through a regulatory minefield. One of the most common questions we hear at Total Benefit Solutions Inc. from employers looking to modernize their benefits strategy is: Can an Individual Coverage Health Reimbursement Arrangement (ICHRA) be used to pay Medicare premiums? The short answer is yes. When structured correctly under federal guidelines, an ICHRA can reimburse Medicare premiums on a tax-advantaged basis, offering incredible flexibility for both your business and your Medicare-eligible staff (including older workers transitioning to retirement or business owners remaining active past age 65). However, navigating… Read More

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The 30% Hammer: What to Do When Your Health Insurance Renewal is a Disaster

Ed MacConnell

It happens every year, but this July feels different. You open the envelope from your health insurance carrier, expecting the usual 5% or 8% “cost of living” increase. Instead, you’re hit with a number that feels like a physical blow: a 30% premium hike. If this sounds familiar, you aren’t alone. Recent data from July 2026 shows that 1 in 5 small businesses across the country are facing renewal increases of 30% or more. For a company with ten employees, that isn’t just a budget adjustment, it’s a threat to your ability to hire, grow, or even stay in business. At Total Benefit Solutions Inc, we call this “The 30%… Read More

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Arizona’s New Health Insurance ‘Gold Rush’: Why Sole Proprietors No Longer Have to Go It Alone

Ed MacConnell

For years, if you were a sole proprietor or a "group of one" in Arizona, your health insurance options were often frustratingly limited. You were stuck between the individual marketplace, where costs can skyrocket and networks can feel narrow, or going without coverage altogether. But as of July 2026, the landscape of Arizona healthcare has fundamentally shifted. A new law, Arizona House Bill 2693 (HB 2693), has officially taken effect, and it is being hailed by industry experts as a "Gold Rush" for entrepreneurs, gig workers, and small business owners across the Grand Canyon State. At Total Benefit Solutions Inc, we’ve been tracking this legislation closely because it represents one… Read More

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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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