Medicare Secondary Payer Rules

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

Ed 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

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Blue Card PPO

Why Everyone Is Talking About Blue Card PPO (And Why Your Remote Team Needs It)

Ed MacConnell

If you’re a small business owner or an HR manager in 2026, you’ve likely noticed that the traditional office is a thing of the past. Your lead developer might be coding from a cabin in Colorado, while your head of marketing is based in a suburban home in Pennsylvania. While this geographic flexibility is a huge win for talent retention, it often creates a massive headache when it comes to group health insurance for employers. How do you provide a health plan that works just as well for someone in rural Montana as it does for someone in downtown Philadelphia? The answer that more and more savvy businesses are turning… Read More

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Member of American Association of Medicare Supplements

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

Lily 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

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How to Choose the Best Group Health Benefits for Small Business (Compared)

Ed MacConnell

Choosing the right group health insurance for employers can feel like trying to navigate a maze without a map. If you are a small business owner, you already know the stakes. Providing group health benefits for small business is one of your biggest expenses, yet it’s also your most powerful tool for attracting and keeping great employees. In 2026, the landscape of healthcare is shifting faster than ever. With median premium increases hitting double digits (often around 11% or higher), the "standard" way of doing things might not be the best way for your bottom line. We see many business owners stuck in a cycle of "renewal shock," where they… Read More

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HSA, HMO, PPO, Oh My! The Ultimate Health Insurance Acronym Cheat Sheet

Ed MacConnell

Does reading your health insurance policy feel like trying to decode a secret government transmission? You aren’t alone. Between the HMOs, the HSAs, and the alphabet soup of other acronyms, it’s easy to feel like you need a law degree just to choose a doctor. At Total Benefit Solutions Inc (www.totalbenefits.net), we see this frustration every day. We’re not just brokers; we’re advocates who believe that you shouldn’t have to learn a second language just to get the medical care you’ve already paid for. Whether you are an individual looking for an ACA (Affordable Care Act) plan or a small business owner trying to provide for your team, this cheat… Read More

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The Ultimate Guide to Ozempic Coverage: How to Fight Denials and Win Your Appeal

Ed MacConnell

If you feel like you’re in a constant wrestling match with your insurance company over Ozempic, you’re not alone. It’s April 2026, and while GLP-1 medications like Ozempic, Wegovy, and Mounjaro have revolutionized healthcare, they’ve also created a massive administrative headache for patients and employers alike. At Total Benefit Solutions Inc., we see these "denial letters" every single day. Most people open them, feel defeated, and assume the fight is over. But here’s the truth: a "no" from an insurance company is often just the beginning of a negotiation. As independent advocates, we’ve learned that the secret to winning isn't just asking nicely, it’s about knowing the rules of the… Read More

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7 Mistakes Contractors Make with Group Health Benefits (And How to Fix Them)

Ed MacConnell

In the construction world, your reputation is built on the quality of your work and the reliability of your crew. As of April 13, 2026, the labor market for skilled trades remains incredibly tight. Finding a good foreman or a reliable HVAC technician is hard enough; keeping them is an entirely different challenge. One of the most powerful tools you have to retain talent is your benefits package. However, many contractors view health insurance as a "necessary evil": a line item on the P&L statement that only goes up every year. Because of this, we often see business owners in the construction industry make critical errors that cost them tens… Read More

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Delaware Paid Leave: What Small Businesses Need to Know in 2026

Ed MacConnell

If you’re a business owner in the First State, you’ve likely spent the last few months (or years) hearing whispers about the "Healthy Delaware Families Act." Well, the future is officially here. As of January 1, 2026, the Delaware Paid Family and Medical Leave (PFML) program is fully operational, and benefits are being paid out to eligible employees across the state. At Total Benefit Solutions Inc, we’ve been fielding calls daily from small business owners who are somewhere between confused and concerned. I get it. Managing a business is hard enough without having to navigate new state mandates, payroll deductions, and employee leave requirements. But here’s the good news: This… Read More

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Why Minimum Value Plans are a Game Changer for Home Health Agencies

Ed MacConnell

For home health agencies (HHAs) across the United States, the business landscape has never been more challenging. Between shifting Medicare reimbursement models, a persistent shortage of skilled nursing talent, and the ever-present pressure of the Affordable Care Act (ACA) mandates, many agency owners feel like they are being squeezed from every direction. At Total Benefit Solutions Inc, we spend a significant amount of time speaking with agency owners who are struggling to find a balance. They want to provide quality benefits to attract and retain caregivers, but they also need to maintain a bottom line that allows the agency to stay operational. The margins in home health are notoriously thin,… Read More

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Total Benefit Solutions #healthinsurance, #healthinsuranceNJ, #horizonbluecross, #IndividualMandate #healthinsurance, #medical #medicare #medicalplans #Medicaid #healplans #totalbenefitsolutions #employee benefits #healthinsurance, #aca, #aca, #obamacarealternatives, #cobra, #pennie, #getcoveredNJ, #medicareadvantage, #medicaresupplements, #totalbenefits #independence #bluecross, #aetna, #unitedhealthcare, #amerihealth, #nippon, #unitedconcordia, #horizon, #AmericanHealthInsurance, #aflac, #aetna, #ICHRA, #HRA, #healthreimbursement, #buckscounty, #healthinsurancenearme, #healthinusrancebuckscounty, #healthinsurancebuckscounty, #healthinsurancenearby, #healthonsurancephiladelphia, #healthinsuranceinPA, #healthinsuranceNJ, #PENNIE, #PENNIEHEALTHINSURANCE, #cobraalternatives, #turning26, #turning65, #adultinghealthinsurance, #healthinsurancenearme, #healthinsurancenearby, #healthinsurancefeasterville, #healthinsurancephilly, #bluecardppo, #minimumessentialplans, #minimumvalueplans, #shorttermhealthplan, #bluecross

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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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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Zepbound coverage for obstructive sleep apnea ends August 1 for current prescriptions.

Loramei Romeo

As part of ongoing adjustments in health insurance coverage, we want to inform that starting August 1, 2025, Independence Edge will remove Zepbound from the Select/Value formularies for treating obstructive sleep apnea for those with existing prescriptions. This change is already in effect for new prescriptions as of May 1, 2025. The decision to terminate Zepbound coverage for OSA treatment was made based on the fact that there are no clinical studies to prove that the drug treats OSA through any other mechanism and its benefit is limited to only weight loss. From August 1, those who continue Zepbound will bear the full cost, although it may be Health Savings… Read More

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Enhancing the security of member portal registrations

Loramei Romeo

Independence Blue Cross has enhanced the security of its member portal and mobile app by introducing a one-day pause during the registration process. This pause allows for additional validation of member data before account activation. Members will receive an email once their account is ready. For immediate access or assistance, members can call 1-844-214-2389. Additionally, updated marketing materials, including flyers on managing health care and benefits online, are available for members and clients. Independence Blue Cross remains committed to safeguarding personal information while ensuring a positive user experience. Have Questions? and want to read more about the changes click Securing member portal registrations for more details. We are dedicated to providing exceptional… Read More

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Message for our valued partners from IBX

Loramei Romeo

IBX, mission is to improve the health and well-being of those we serve. We are committed to innovation to reduce costs, provide equitable, holistic health care, and simplify the user experience for everyone we have the privilege to serve. To achieve these objectives, we embarked on an ambitious plan two years ago to transition our business to a more modern, flexible platform. This plan aims to streamline processes, enhance accuracy, and improve plan configurability, resulting in a more modern, personalized, and enhanced user experience. We appreciate your support and partnership in this ambitious endeavor. We acknowledge that some of these changes have presented challenges, and your understanding and support have… Read More

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