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

Ed MacConnell

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

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The Quiet Death of the PPO: What Small Businesses Need to Know About 2026 Plans

Ed MacConnell

For years, the Preferred Provider Organization (PPO) was the undisputed gold standard for small business health insurance. If you were a business owner who wanted to recruit and retain the best talent, you offered a PPO. It sent a clear message to your employees: "We trust you to manage your own health, and we’re giving you the freedom to see any doctor, anywhere." But as we look toward the 2026 plan year, that gold standard is starting to show some serious rust. In fact, if you look closely at the filings and the carrier trends, the traditional broad-network PPO is undergoing a "quiet death." Carriers are slowly but surely phasing… Read More

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

Ed 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

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Dr Ben E Fitz Total Benefit Solutions, Inc

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

Ed 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

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Dr Ben E Fitz Total Benefit Solutions, Inc

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

Ed 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

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

Ed 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

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

Ed 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

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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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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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Medicare Secondary Payer Rules: A Quick-Start Guide for Employers with 65+ Staff

Ed MacConnell

As we move further into 2026, the landscape of the American workforce continues to shift. More than ever, we are seeing valued team members choose to work well past the traditional retirement age of 65. While having that experience and institutional knowledge on your team is a massive win for your business, it does introduce a specific layer of complexity regarding your employee benefits strategy. The biggest question we get here at Total Benefit Solutions Inc is often some variation of: "My top salesperson just turned 65. Do they have to go on Medicare, and who pays their medical bills first?" The answer lies within the Medicare Secondary Payer (MSP)… 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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