Health insurance Updates – Total Benefit Solutions Inc

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

July 14, 2026July 14, 2026Ed MacConnellNo Comments

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

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

July 7, 2026July 8, 2026Ed 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

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

July 6, 2026July 8, 2026Ed 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

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

July 3, 2026July 8, 2026Ed 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

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

June 26, 2026July 8, 2026Ed 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

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

June 16, 2026June 18, 2026Ed 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

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

June 12, 2026June 18, 2026Ed 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

Main Line Health vs. UnitedHealthcare: Will You Lose Your Doctor on July 1st?

June 11, 2026June 18, 2026Ed MacConnell

If you live in the Philadelphia suburbs, you probably know Main Line Health (MLH) as the backbone of local healthcare. From Lankenau Medical Center to Paoli Hospital, their physicians and facilities have been staples in our community for decades. However, a major contract dispute with UnitedHealthcare (UHC) is threatening to disrupt care for thousands of families. As of right now, the clock is ticking toward a June 30, 2026, deadline. If a new agreement isn’t reached by then, Main Line Health will officially become an out-of-network provider for most UnitedHealthcare commercial and Medicare Advantage plans starting July 1st. At Total Benefit Solutions Inc., we’ve seen these "carrier vs. provider" battles… Read More

The HHA Retention Crisis: Is Your Health Plan Actually Just a Resignation Letter?

June 9, 2026June 18, 2026Ed MacConnell

Maria sat in her office, the glow of her laptop screen the only light in the room. It was 7:30 PM on a Friday. Most of her friends were at dinner, but Maria was staring at an exit interview form, the fourth one this month. Her agency, "Graceful Care," was doing everything right. They had a waiting list of clients and a reputation for excellence. But Maria was losing the "Home Health Hustle." She was losing her best aides to the local hospital system, and she was losing her mind trying to replace them. "I offer health insurance," she told us when she first called Total Benefit Solutions Inc. "I… Read More

Dr Ben E Fitz Total Benefit Solutions, Inc

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

May 27, 2026June 4, 2026Ed MacConnell

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, 2026June 4, 2026Ed MacConnell

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

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

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

May 20, 2026May 20, 2026Ed MacConnell

Let’s be honest: most small business owners would rather read the fine print on a shampoo bottle than dive into the federal register. But when it comes to Medicare Secondary Payer (MSP) rules, “ignorance is bliss” is a high-speed ticket to a financial car crash. At Total Benefit Solutions Inc, we spend our days navigating the labyrinth of health insurance regulations so you don’t have to. We’ve seen it all, from small shops accidentally triggering massive fines to large corporations tripping over the “Section 111” paperwork monster. If you are providing group health insurance for employers, you are already in the crosshairs of these rules. To help you stay on… 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

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

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

May 11, 2026May 13, 2026Ed 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

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 #medicare Supplements #medicaresupplements

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

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

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

May 5, 2026May 7, 2026Ed 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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Level Funded vs. Fully Insured: Which Is Better For Your Trucking Company?

May 4, 2026May 4, 2026Ed MacConnell

If you’re running a trucking company in 2026, you already know that the road isn’t just getting longer: it’s getting more expensive. Between fluctuating fuel costs, maintenance, and the constant battle to keep good drivers behind the wheel, your margins are constantly under pressure. One of the biggest line items on your balance sheet is likely health insurance. For years, the "safe" choice was a traditional fully insured plan. You pay the premium, the insurance company takes the risk, and everyone moves on. But as premiums continue to climb by double digits year after year, many fleet owners are asking: Is there a better way? At Total Benefit Solutions Inc,… Read More

The MAGI Hack: How Early Retirees Can Save $15,000 on Health Insurance Before 65

May 1, 2026May 1, 2026Ed MacConnell

You’ve finally done it. You’ve put in your thirty-plus years, the house is mostly paid off, and you’re ready to trade the morning commute for morning coffee on the porch. But there’s one giant, expensive hurdle standing between you and the finish line: The Medicare Gap. If you’re 60, 61, or 62 years old, you’re in the "health insurance danger zone." You are too young for Medicare (which starts at 65), and if you aren't careful, you could be staring at health insurance premiums that look like a second mortgage, sometimes $1,500 to $2,000 a month for a couple. At Total Benefit Solutions Inc, we see early retirees panic when… Read More

The 3-Tier Strategy: How Keystone Proactive Plans Save Your Team Money

April 27, 2026May 1, 2026Ed MacConnell

Let’s be honest: most people look at their health insurance plan once a year during open enrollment, get a headache from the jargon, and then tuck the ID card into their wallet hoping they never have to use it. But as a business owner or HR manager, you don’t have that luxury. You’re watching premiums climb every single year, and you’re looking for a way to give your employees great coverage without draining the company's bank account. At Total Benefit Solutions, we’ve seen every plan under the sun. Right now, one of the most effective tools in our arsenal for small and mid-sized businesses in the Philadelphia area is the… Read More

A man turning age 26 who needs health insurance

The Birthday Scaries: Turning 26 and Losing Your Parents’ Health Insurance

April 27, 2026May 1, 2026Ed MacConnell

Happy birthday! You’ve finally hit the big 2-6. You’re officially a “real” adult in the eyes of the healthcare world. While that usually means a nice dinner or a weekend getaway, for many, it also brings a sudden, cold realization. The “Birthday Scaries” are real, and they usually hit right when you realize you are officially off your parents’ health insurance plan. One day you’re covered, and the next, you’re staring at a world of deductibles (the amount you pay out of pocket before insurance kicks in) and premiums (your monthly bill) all on your own. Don’t panic. At Total Benefit Solutions Inc, we’ve helped thousands of young professionals navigate… Read More

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