Pennie Health Insurance – Total Benefit Solutions Inc

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

May 7, 2026May 7, 2026Ed MacConnellNo Comments

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 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

A man feeling alone turning age 25 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

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

April 26, 2026May 1, 2026Ed 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

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

April 20, 2026May 1, 2026Ed 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

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

April 13, 2026May 1, 2026Ed 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

The Big Insurance Lie: Why your small business is probably overpaying for “peace of mind” (and how to stop)

April 11, 2026May 1, 2026Ed 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

MVP vs. MEC: The Compliance Difference That Could Cost You Thousands

April 8, 2026May 1, 2026Ed 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

The ‘Minimum’ Plan That Doesn’t Mean Minimum Advocacy

April 6, 2026May 1, 2026Ed MacConnell

When you hear the word "minimum," what comes to mind? Usually, it’s the bare essentials. The absolute basement. The least amount you can do to get by without getting in trouble. In the world of employee benefits, a "Minimum Value Plan" (MVP) often carries that same stigma. Many business owners view these plans as a "check-the-box" compliance strategy, a way to avoid those stinging Affordable Care Act (ACA) penalties without breaking the bank. Because these plans sit at the lower end of the cost spectrum, there is a dangerous assumption that the service, support, and advocacy attached to them must also be "minimum." At Total Benefit Solutions, we think that’s… Read More

A new Special Enrollment Period has been created allowing select beneficiaries in Pennsylvania to shop for coverage until April 30

April 4, 2026May 1, 2026Lily 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

Reference Based Pricing Explained in Under 3 Minutes: The Secret to Affordable Group Health Insurance

March 30, 2026May 1, 2026Ed MacConnell

If you’re a small to mid-sized business owner, you’ve likely watched your health insurance premiums climb year after year. You’re doing everything right: managing your overhead, growing your team, and taking care of your customers: yet your "second largest expense" keeps eating into your profit margins. It’s frustrating, and frankly, the traditional insurance model feels rigged against you. At Total Benefit Solutions, we don’t believe you should have to choose between providing quality benefits and keeping your business profitable. There is a better way to do this, and it’s called Reference Based Pricing (RBP). If you have three minutes, I can explain exactly how this "secret" works and why it’s… Read More

Don’t Get Burned by ACA Penalties: How Minimum Value Plans Save Your Bottom Line

March 30, 2026May 1, 2026Ed MacConnell

If you’re running a business in 2026, you already know that the IRS doesn’t send "friendly reminders" when it comes to the Affordable Care Act (ACA). They send bills. And lately, those bills have been getting a lot more expensive. At Total Benefit Solutions, we’ve seen too many hard-working business owners get blindsided by the Employer Shared Responsibility (ESR) payments because they thought their "standard" plan covered them. The reality is that just "having insurance" isn't enough to satisfy the federal government. To protect your bottom line, your plan must meet a very specific threshold called Minimum Value (MV). If it doesn't, and even one of your employees goes to… Read More

ACA Compliance 101: Is Your Health Plan Actually Meeting Minimum Value?

March 23, 2026May 1, 2026Ed MacConnell

If you are a business owner or an HR director, you’ve probably heard the term "Minimum Value" thrown around more times than you can count during open enrollment. But here is the reality: "Minimum Value" isn’t just a buzzword or a checkbox on a government form. It is a legal threshold that determines whether your business is protected from massive IRS penalties or if you are sitting on a ticking financial time bomb. As we move through 2026, the stakes have never been higher. At Total Benefit Solutions, we don’t just look at spreadsheets; we act as your frontline advocates. We’ve seen too many employers get sold "budget" plans that… Read More

Lost Your Job? Here’s Your Complete Guide to Health Insurance Options (COBRA vs ACA vs Medicaid Compared)

December 6, 2025December 23, 2025Ed MacConnell

Losing your job hits hard enough without worrying about losing your health insurance too. The good news? You’ve got options, and we’re going to walk through every single one so you can make the smartest choice for your situation. Here’s the reality: You have 60 days from your last day of coverage to make a decision. That might seem like plenty of time, but trust me: these 60 days fly by when you’re dealing with job searches, unemployment paperwork, and everything else that comes with a career transition. The three main paths forward are COBRA (continuing your old employer’s plan), ACA Marketplace plans (buying individual coverage), and Medicaid (government assistance… Read More

Next Year Cost for Pennie Customers May Increase

April 29, 2025April 29, 2025Loramei Romeo

Pennie has announced that enrollees receiving advance premium tax credits will likely face higher costs in 2026 due to the expiration of enhanced federal tax credits at the end of 2025. This change will result in increased monthly premiums for most enrollees unless Congress acts to extend these credits. Pennie is committed to keeping customers informed through various communications, including postcards, emails, and text messages, to help them understand the upcoming changes and find the lowest costs on high-quality health coverage. The enhanced tax credits, introduced in 2021, have provided significant financial savings, but their expiration means reduced savings for many enrollees starting January 2026. We are dedicated to providing… Read More

South Jersey Radiology is in the Clover Network

April 11, 2025April 11, 2025Loramei Romeo

New In-Network Providers Effective April 1st. Clover Health is constantly working to expand our provider network to give our members more choice of in-network providers that will save them money with lower copays. We’ve added the following providers to our network effective 4/1/2025. New Providers HR Health Care Patient Dispatch Health Management – Multi-Specialty Services Texas & Pennsylvania Dr. Joseph Wolf SchatzSpecialist, PsychiatryMontgomery County, PA River City Internal MedicinePCPTX Vascular and Interventional Specialists, PCSpecialistMiddlesex County, PA New Jersey Alejandro Flores, DSW, LCSWSpecialist, PsychologyMiddlesex County, NJ JR Physical Therapy, LLCPT/OT, Physical TherapyBergen County, NJ DASMD ClinicPCPBergen County, NJ Total Rehab MoorestownSkilled Nursing FacilityNJ Metuchen Family Medicine, LLCSpecialist, Family MedicineMiddlesex County, NJ Bill Powell… Read More

Small Employer Open Enrollment Period November 15 through December 15

October 24, 2024October 24, 2024Ed MacConnell

While this has been in place for a number of years, we would like to remind you about the Small Employer Open Enrollment Period for fully insured health plans in all states. The Small Employer Open Enrollment Period is the period from November 15 through December 15 each year. During this period, employers that meet the definition of small employer but do not meet the carrier’s participation or contribution requirement will be accepted for a small employer plan with a January 1 effective date. Additionally, select carriers in New York may allow for a December effective date if applicable. Carriers require that employer groups enrolling under the Small Employer Open Enrollment Period submit completed applications… Read More

2025 Part D Changes and Employer Sponsored Group Health Plans

September 9, 2024September 5, 2024Mirasol Bandong

Employers must inform the Centers for Medicare and Medicaid Services (“CMS”) and participants and beneficiaries who qualify for Medicare Part D of the creditable or non-creditable status of the group health plan prescription drug plan(s). When prescription medication coverage meets or exceeds Medicare Part D, it is considered creditable. Any coverage that falls short of Medicare Part D’s quality standards is deemed non-creditable As previously reported, the Inflation Reduction Act of 2022 (“IRA”) changed aspects of the Medicare Part D program to enhance and improve Medicare Part D coverage. The changes include: As a result of these changes, some employer sponsored prescription drug coverage may no longer qualify as creditable… Read More

Ready for another year of helping clients who get their health insurance through Pennie!

September 8, 2024September 8, 2024Ed MacConnell

Ready for another year of helping clients who get their health insurance through Pennie! Open enrollment starts November 1st 2024 and ends January 15th 2025! (215)355-2121 https://lnkd.in/bhhqqAJ

Cigna Changes to MA ID cards

August 26, 2024August 23, 2024Mirasol Bandong

As with the 2025 plan year, our Medicare Advantage ID cards will be altered. By utilizing our digital portals to obtain a member’s current PCP, treating providers will be encouraged to use them more efficiently, which will prevent needless treatment delays brought on by the referral process. See what’s changing below, so you’re ready to answer any customer questions this upcoming AEP. What’s changing? 2024 2025 What is staying the same? When are these changes occurring? Members in HMO plans are still required to maintain a PCP New enrollees with a 1/1/2025 effective date will start receiving ID cards without PCP information as soon as 10/15/2024. The PCP network name… Read More

Tower Health is back!

July 26, 2024July 23, 2024Mirasol Bandong

Tower Health is back in Cigna Medicare Advantage network in Pennsylvania! After productive negotiations with Tower Health in Pennsylvania, Cigna is happy to announce that they are back in their Medicare Advantage network effective June 1, 2024. This includes Phoenixville and Pottstown Hospital, all Primary Care Physicians (PCPs), specialists, ancillary providers, and other hospitals that were previously in-network. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

Disaster Special Election Periods in several states

July 15, 2024July 12, 2024Mirasol Bandong

This is an important announcement for customers in Arizona, California, Florida, Iowa, Kansas, Maryland, Minnesota, New Mexico, North Carolina, Oregon, Texas and West Virginia and for those with business in these states. The counties below are under a federal or state designated SEP due to an emergency. Applications for disaster SEP are only accepted as long as the SEP declaration is in place. For the most recent information, if a deadline is not specified below, please use Producers’ University’s Ongoing SEP tracker. Applications for SEPs submitted after the declaration date of that SEP will not be accepted. IMPORTANT : Please be aware The SEP begins on the date of the incident’s start, if that occurs earlier, or on… Read More

Special Enrollment Period Extended: Florida Emergency Declaration – Hurricane Idalia

June 28, 2024June 28, 2024Mirasol Bandong

Please be advised that a state of emergency was extended for certain Florida counties. This declaration allows for a one-time Special Enrollment Period (SEP), in the event beneficiaries were unable to make an election during another qualifying election period. Please reference the following guidelines for the incident period. This DST-SEP applies to the Florida counties listed below. Important Compliance Information Who is eligible: This SEP opportunity is ONLY available to beneficiaries who: Details : Impacted Counties: Alachua, Baker, Bay, Bradford, Brevard, Calhoun, Charlotte, Citrus, Clay, Collier, Columbia, DeSoto, Dixie, Duval, Flagler, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Hardee, Hernando, Hillsborough, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Nassau, Orange, Osceola, Pasco, Pinellas,… Read More

Disaster Special Election Periods in several states

June 24, 2024June 20, 2024Mirasol Bandong

This is an important announcement for customers in Arizona, Arkansas, Colorado, Florida, Idaho, Mississippi, Nevada, Oklahoma and Texas and for those with business in these states. The counties below are under a federal or state designated SEP due to an emergency. Applications for disaster SEP are only accepted as long as the SEP declaration is in place. For the most recent information, if a deadline is not specified below, please use Producers’ University’s Ongoing SEP tracker. Applications for SEPs submitted after the declaration date of that SEP will not be accepted. IMPORTANT : Please be aware The SEP begins on the date of the incident’s start, if that occurs earlier, or on the declaration date. The SEP… Read More

You can access your PCORI membership report on uhceservices.com

June 19, 2024June 18, 2024Mirasol Bandong

Under the Affordable Care Act (ACA), health insurers, and plan sponsors are responsible for paying the PCORI fee. The Patient-Centered Outcomes Research Institute (PCORI) fee also helps fund research that evaluates and compares health outcomes, clinical effectiveness, and the risks and benefits of medical treatments and services. Sponsors of self-funded (ASO) plans are required to submit Form 720 and pay the PCORI fee to the Internal Revenue Service (IRS) immediately. The payment must be made by July 31 of the year that follows the conclusion of the plan year. A PCORI Membership Report is given to UnitedHealthcare Level Funded groups whose plan year ends in 2023 to help with PCORI fee… Read More

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