AARP Medicare – Total Benefit Solutions Inc

Do You Really Need Minimum Value Plans? The Truth About the 2026 ACA Affordability Hike

May 29, 2026Ed MacConnellNo Comments

Navigating the world of employee benefits often feels like trying to read a map that changes every time you look at it. If you are a business owner or a HR manager, you’ve likely heard whispers about the upcoming "Affordability Hike" for 2026. This isn’t just another minor adjustment to the rules. The IRS recently released Revenue Procedure 2025-25, which sets the new standards for what constitutes "affordable" health insurance under the Affordable Care Act (ACA). At Total Benefit Solutions Inc, we believe that staying ahead of these changes is the only way to protect your business from hefty penalties. We act as your independent advocate, cutting through the bureaucracy… Read More

Dr. Ben E. Fitz and the Mandated Leave Maze: Survival Guide for 2026

May 28, 2026Ed MacConnellNo Comments

Welcome to 2026, where the only thing rising faster than the morning sun is the complexity of state-mandated benefit laws. If you feel like you’re wandering through a hedge maze without a map, you aren’t alone. Small and medium-sized business (SMB) owners across the country are currently facing a "tug-of-war" that would make a professional athlete sweat. On one side, you want to provide top-tier benefits to keep your best talent; on the other, you’re trying to keep the lights on while insurance premiums continue to climb. I’m Dr. Ben E. Fitz, and today we’re going to talk about the newest wall in that maze: Mandated Paid Family Leave (PFML).… Read More

Care for the Caregivers: Unique Benefits Home Health Teams Actually Want

May 27, 2026Ed MacConnellNo Comments

If you run a home healthcare agency, you already know the statistics: but that doesn’t make them any easier to swallow. Currently, the home-based care industry is facing a turnover crisis that would make most business owners' heads spin. Recent data shows that caregiver turnover has hit a staggering 77%, with nearly four out of five caregivers leaving within their first 100 days of employment. In the "war for caregivers," the traditional approach to group health insurance for employers isn't enough anymore. When your margins are being squeezed by Medicare and Medicaid rate changes, and your staff is constantly being recruited by the agency down the street, you need a… Read More

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

May 27, 2026Ed MacConnellNo Comments

Listen, we get it. Running a small business is like trying to change a tire on a car that's currently doing 70 mph on the turnpike. You’ve got payroll to manage, customers to keep happy, and somewhere in that pile of paperwork is a folder labeled "Medicare Secondary Payer (MSP) Rules" that looks about as appetizing as a week-old tuna sandwich. But ignoring these rules isn’t just a bad idea; it’s a financial gamble you’re probably going to lose. The federal government has very specific ideas about who should pay for health insurance claims first, your company's plan or Medicare. If you get it wrong, the penalties aren’t just a… Read More

Closing the Gap: How Voluntary Benefits Protect Your Team from High Deductibles

May 25, 2026May 28, 2026Ed MacConnell

WordPress Category: Medicare For many business owners, providing health insurance is a balancing act between offering quality care and managing the rising cost of premiums. In recent years, the solution for most has been the High-Deductible Health Plan (HDHP). While HDHPs are an effective way to lower monthly premiums and provide employees with access to Health Savings Accounts (HSAs), they often leave a significant "gap" in coverage. This gap is the distance between when a medical event happens and when the insurance company actually starts paying the bills. At Total Benefit Solutions Inc, we see the fallout of this gap every day. We’ve watched as hard-working employees face sudden financial… Read More

Supreme Court Clears the Path: Lower Medicare Drug Prices are Officially Coming

May 23, 2026May 27, 2026Ed MacConnell

The landscape of healthcare in America just took a significant turn toward affordability. In a landmark moment for seniors across the country, the Supreme Court has declined to hear a major challenge to the Medicare Drug Price Negotiation Program. This decision marks the end of a long legal battle initiated by some of the world's largest pharmaceutical companies. By refusing to take up the case, the highest court in the land has effectively cleared the path for the federal government to negotiate prices directly with drug manufacturers, a move that was once prohibited by law. At Total Benefit Solutions Inc, we’ve been watching this case closely. Our mission is to… Read More

Infographic: Navigating the 2027 Medicare Part D Overhaul

May 22, 2026May 27, 2026Ed MacConnell

Buckle up, because the world of medicare drugs is getting a total makeover. If you’ve spent any time navigating the maze of Medicare Part D over the last decade, you probably remember the dreaded "Donut Hole", that confusing gap in coverage that felt like falling into a financial pit just when you needed help the most. Well, by 2027, the Donut Hole isn't just closed; it’s ancient history. At Total Benefit Solutions Inc, we spend our days (and sometimes our nights) digging through federal regulations so you don't have to. We are health insurance advocates who never accept "no" for an answer, especially when it comes to your benefits. Our… Read More

Referenced Based Pricing Health Insurance Benefits

Reference Based Pricing: How to Stop Paying “Retail” for Your Employees’ Healthcare

May 21, 2026May 21, 2026Ed MacConnell

WordPress Category: Medicare If you walked into a car dealership and the salesperson told you the MSRP for a basic sedan was $450,000, but “just for you,” they could offer a 90% discount to bring it down to $45,000, you’d walk out. You’d know the “retail” price was a total fiction designed to make the final price look like a steal. Yet, this is exactly how most businesses buy healthcare for their employees today. We call it the “PPO Discount Illusion.” Your insurance carrier shows you a massive “discount” on a hospital bill, but because the original starting price (the “chargemaster” rate) was astronomically high and arbitrary, you’re still overpaying.… Read More

The PEO Puzzle: Is Co-Employment a Dream or a Trap for Your Business?

May 20, 2026May 20, 2026Ed MacConnell

For many small to mid-sized business owners, managing employee benefits feels like a second full-time job. You want to offer affordable group health insurance, but the sheer weight of payroll, compliance, and administration can be suffocating. Enter the PEO, or Professional Employer Organization. A PEO promises to take the burden off your shoulders, offering "big company" benefits and high-tech HR systems. It sounds like a dream, but for some, it quickly turns into a "black box" of hidden costs and lost control. So, is co-employment the right move for your company in 2026? At Total Benefit Solutions Inc, we believe in looking under the hood before you sign on the… Read More

May 19, 2026Ed MacConnell

Category: Medicare Things change if you are on Medicare due to a disability rather than age. The government gives larger employers more responsibility here. Large Group Health Plan (100+ Employees): If the employer has 100 or more employees, the employer plan pays Primary. Smaller Groups (Under 100 Employees): Medicare pays Primary. This is a common "gotcha" for businesses with 50 or 75 employees. They are used to being "Primary" for their 65+ workers, but for a disabled employee on Medicare, the roles flip! (It’s enough to give anyone a headache, which is why we’re here to help.) 4. How Do You Count "Employees" Anyway? You’d think counting to 20 or… Read More

Beyond Health: Why Group Life and Disability Are the Secret Sauce for Retention

May 18, 2026May 18, 2026Ed MacConnell

Category: Medicare In the competitive landscape of 2026, health insurance is no longer a "perk", it is a baseline expectation. For small and medium-sized businesses looking to attract and keep top-tier talent, offering a medical plan is simply the price of entry. To truly stand out and create a culture of loyalty, savvy employers are looking beyond the doctor's office. They are looking at Group Life and Disability insurance. Often called the "ancillary" benefits, these two coverages are the secret sauce for employee retention. While health insurance helps employees pay for getting well, life and disability insurance ensure their families stay financially well if the unthinkable happens. At Total Benefit… Read More

Laughter is the Best (Secondary) Policy: A Collection of Insurance Broker Humor

May 17, 2026May 18, 2026Ed MacConnell

Let’s be honest: navigating the world of health insurance can often feel like trying to solve a Rubik’s Cube while blindfolded, and the cube is on fire. At Total Benefit Solutions Inc, we spend our days knee-deep in policy manuals and government regulations (the "un-fun" stuff), so we know exactly how stressful this industry can be. Sometimes, the only way to handle a denied claim or a rising premium is to take a deep breath and find the humor in the situation. After all, if we didn't laugh, we might just start eating our own deductible (the amount you pay out-of-pocket before your insurance kicks in). To lighten your day,… Read More

A Little Health Insurance Humor: The Deductible Dilemma

May 16, 2026May 18, 2026Ed MacConnell

We’ve all been there. You’ve spent the entire year tracking every co-pay, every prescription, and every specialist visit like a detective on a high-stakes case. You finally hit that magic number, the annual deductible, and you’re ready to let the insurance company take the wheel for a bit. Then you look at the calendar. It’s December 31st. In about six hours, that beautiful, $0-out-of-pocket horizon is going to reset faster than a New Year’s resolution. It’s the ultimate "so close, yet so far" moment in adulting. Why the Deductible Dance is So Hard Navigating health insurance can feel like trying to solve a Rubik's Cube while wearing oven mitts. Between… Read More

Level Funding: The Small Business “Cheat Code” for Better Health Benefits

May 14, 2026May 14, 2026Ed MacConnell

Category: Medicare If you own a small or medium-sized business, you know the annual "renewal dance" all too well. Every year, your health insurance carrier sends a letter that looks like a ransom note, demanding a 10%, 15%, or even 20% premium increase. You’re told it’s because of "market trends" or "rising healthcare costs," even if your employees didn’t even use their insurance much last year. It feels like you're throwing money into a black hole. In a traditional "fully insured" plan (the kind most small businesses have), the insurance company keeps every penny of your premium, whether your team is healthy or not. If you pay $100,000 in premiums… Read More

Urgent Medicare Alert: Clear Spring Health Exiting 3 States– Don’t Lose Your Benefits!

May 13, 2026May 13, 2026Ed MacConnell

If you are a Medicare beneficiary in Illinois, Georgia, or Colorado, you need to check your mail, and your insurance card, immediately. Clear Spring Health has officially announced its complete exit from the Medicare Advantage market in these three states. This isn’t a “next year” problem; it is happening right now. Coverage for every single enrolled member will officially end at midnight on May 31, 2026. At Total Benefit Solutions Inc, we know how stressful it is to hear that your health coverage is vanishing mid-year. As your health insurance advocates, we are here to ensure you don’t fall through the cracks of this transition. You have less than three… Read More

The May 2026 Medicare Updates Everything You Need to Know Now

May 13, 2026May 13, 2026Ed MacConnell

Welcome to your essential update for May 2026. If you’ve been feeling like the world of health insurance is moving faster than you can keep up with, you aren’t alone. Between shifting pharmaceutical programs and complex federal regulations, staying informed is a full-time job. Luckily, it’s our full-time job. At Total Benefit Solutions Inc, we don’t just watch the changes; we navigate them for you. This month, we have three major updates that will impact how you access care, how much you pay for prescriptions, and how your business stays compliant with Medicare rules. The July 2026 Ozempic/GLP-1 “Bridge Program” One of the most frequent questions we’ve received lately is:… Read More

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

May 13, 2026May 13, 2026Ed MacConnell

So, your business is growing, your team is aging like a fine wine, and suddenly, you’ve got employees hitting that magical number: 65. Congratulations! You’ve reached the level of the “Medicare Secondary Payer” (MSP) boss fight. If that sounds intimidating, it’s because it can be. Medicare Secondary Payer rules are essentially the government’s way of saying, “We aren’t paying for this if someone else can.” At Total Benefit Solutions Inc, we spend our days navigating these regulatory minefields so you don’t have to step on a $1,000-per-claim landmine. Whether you’re offering group health insurance for employers or looking into affordable group health insurance options, understanding MSP is non-negotiable. Here are… Read More

The Ozempic Odyssey: Navigating Medicare Coverage Without the Headache

May 12, 2026May 13, 2026Ed MacConnell

If you’ve turned on a television or scrolled through social media lately, you’ve heard the names: Ozempic, Wegovy, Zepbound. These GLP-1 medications have completely transformed the conversation around weight management and chronic disease. But for those of us on Medicare, the conversation has often been a short one: "No, Medicare doesn't cover weight loss drugs." For years, that 2003 federal law (the Medicare Modernization Act) has acted like a brick wall, explicitly banning coverage for medications used solely for weight loss. At Total Benefit Solutions Inc, we don't like the word "no." Neither does our resident expert, Dr. Ben E. Fitz. Today, we’re breaking down the complex odyssey of Medicare… Read More

Big News: We’ve Joined the American Association for Medicare Supplement Insurance (AAMSI)!

May 11, 2026May 13, 2026Ed MacConnell

If you’ve been hanging around Total Benefit Solutions Inc for more than five minutes, you know we don’t do things halfway. Whether we’re fighting a denied claim until the insurance company basically begs us to stop calling (we won’t) or navigating the labyrinth of federal regulations, we’re all in. That’s why I’m beyond excited to share some major news. I’ve officially joined the American Association for Medicare Supplement Insurance (AAMSI). You can even check out my shiny new profile right here. Now, I know what you’re thinking: "Ed, another acronym? Really?" But hang with me for a second, because this isn’t just a badge for my email signature. It’s a… Read More

Member of American Association of Medicare Supplements

Total Benefit Solutions is Now an Official Member of the American Association for Medicare Supplement Insurance

May 8, 2026May 10, 2026Lily Dalton

We’re proud to announce that Total Benefit Solutions is now an official member of the American Association for Medicare Supplement Insurance (AAMSI)! AAMSI is a nationally recognized organization dedicated to supporting professionals who specialize in Medicare and Medicare Supplement insurance. Their mission is to promote education, ethical standards, and consumer awareness within the Medicare industry. Becoming a member of AAMSI reflects our ongoing commitment to providing trusted guidance, reliable information, and personalized support to every client we serve. As part of this respected organization, Total Benefit Solutions gains access to valuable industry resources, continued education, and up-to-date Medicare insights — helping us better serve our clients with confidence and care.… Read More

The 2026 ACA Affordability Rule Explained in Under 3 Minutes

May 8, 2026May 10, 2026Ed MacConnell

— If you’re a business owner or an HR manager, you know that health insurance rules change faster than the weather in Philadelphia. One minute you’re settled into your 2025 plan design, and the next, the IRS drops a new percentage that changes how much you can charge your team for coverage. The 2026 ACA Affordability threshold has officially been announced, and it’s a big one. For the first time in a while, we’re seeing a significant jump in the percentage. We know you’re busy. That’s why we’ve broken down everything you need to know about affordable group health insurance requirements for 2026 in a post that takes less time… Read More

Member of American Association of Medicare #medicare Supplements #medicaresupplements

Why Everyone Is Talking About the New Medicare GLP-1 Bridge (And You Should Too)

May 7, 2026May 8, 2026Ed MacConnell

If you’ve turned on a television, scrolled through social media, or even just sat in a doctor’s waiting room lately, you’ve heard the names. Ozempic. Wegovy. Zepbound. These GLP-1 medications (Glucagon-like peptide-1 receptor agonists) have basically become the “iPhone” of the medical world, everybody wants one, but the price tag can make your eyes water. For years, if you were on Medicare, the conversation usually ended with a polite but firm “No.” Federal law literally forbade Medicare from covering drugs specifically for weight loss. It was a frustrating “Catch-22” (a situation where you can’t win because of contradictory rules): you were encouraged to get healthy, but the most effective tools… Read More

Why Your Hospital Bills Are Total Fiction (And How Reference-Based Pricing Fixes It)

May 7, 2026May 7, 2026Ed MacConnell

If you’ve ever opened a hospital bill and felt your heart stop for a second, and not because of the medical condition you were there for, you aren’t alone. We’ve all seen it: a $50 charge for a single Tylenol pill or a $3,000 bill for a fifteen-minute "consultation" that felt more like a quick "hello." Here’s the dirty little secret the healthcare industry doesn't want you to know: those numbers are almost entirely made up. In the world of health insurance and hospital billing, the prices you see on your statement are part of a document called the Chargemaster. Think of the Chargemaster as the "MSRP" (Manufacturer’s Suggested Retail… Read More

The ‘Blue Card’ Hack: How to Get National PPO Access on a Local Budget

May 6, 2026May 7, 2026Ed MacConnell

If you’re a small business owner in Pennsylvania or New Jersey, you’ve likely felt the "geographic squeeze." You want to offer your team top-tier health insurance, but as soon as you look at national PPO plans, the premiums start looking like a mortgage payment for a small island. Most employers think they have two choices: pay a fortune for a "name brand" national plan or stick to a local HMO that leaves their remote workers or frequent travelers stranded without coverage. But there’s a third option, a "hack," if you will, that many brokers don’t explain clearly. It’s called the Blue Card PPO program. It’s the secret to getting a… Read More

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

May 6, 2026May 7, 2026Ed MacConnell

Let’s be honest: talking about Medicare Secondary Payer (MSP) rules is about as exciting as watching paint dry in a room full of accountants. But here’s the kicker, if you’re a small business owner, ignoring these rules is a great way to watch your hard-earned profits vanish into a black hole of federal fines. At Total Benefit Solutions Inc, we spend our days navigating the labyrinth of group health insurance for employers, and we’ve seen it all. We know that you’re just trying to provide affordable group health insurance without getting slapped by Uncle Sam. CMS (the Centers for Medicare & Medicaid Services) has a very specific sense of humor,… Read More

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