Individual 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 ‘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

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

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

HRAs Growing for Small Businesses

April 3, 2026May 1, 2026Lily 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

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

ACA Employer Mandate penalties are the highest ever

March 20, 2026May 1, 2026Ed 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.

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

Trump Administration Issues Final Rule Impacting the ACA’s Marketplace

August 12, 2025August 29, 2025Loramei Romeo

On June 25, 2025, the U.S. Department of Health and Human Services (HHS) published a final rule to implement newstandards for the Affordable Care Act’s (ACA) Marketplaces (or Exchanges). According to HHS, improper Exchangeenrollments, enabled by weakened verification processes and expanded premium subsidies, have triggered “widespreadfraud.” The final rule’s changes are intended to address these problems with the goal of improving health care affordabilityand access while maintaining fiscal responsibility. Key ChangesMany of the final rule’s changes are effective 60 days after its publication date, or Aug. 25, 2025, although some provisionshave a later effective date. Also, some changes are temporary measures that sunset at the end of the 2026 plan… Read More

How will Aetna’s departure affect ACA exchanges?

May 19, 2025Loramei Romeo

Aetna’s decision to withdraw from the Affordable Care Act (ACA) marketplaces in 17 states by the end of 2025 raises questions about the stability and future of these exchanges. While it’s uncertain if other carriers will follow Aetna’s lead, the history of the ACA marketplace has been marked by a dynamic pattern of exits and entries. We understand that navigating the ever-changing regulations and economic challenges can be daunting for consumers seeking health insurance. The future of health insurance exchanges is uncertain, which is why it’s crucial to emphasize policy stability and market adaptability. The ACA exchanges play a vital role in providing access to health insurance, but they do… Read More

IRS just announced the 2026 Health Savings Account Contribution Limits

May 12, 2025May 7, 2025Loramei Romeo

As we look ahead to 2026, it’s important to understand the new contribution limits for health plans. The self-only contribution limit has increased to $4,400, while the family limit is now $8,750. Additionally, the annual deductible for high-deductible health plans has also seen increases, with self-only coverage now requiring a deductible of at least $1,700 and family coverage at $3,400. Staying informed about these changes is crucial for optimizing employee benefits and promoting financial well-being. How is your organization adapting to these new health plan regulations? 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… Read More

ACA Individual Market Highmark

May 8, 2025May 6, 2025Loramei Romeo

On May 2, 2025, Crozer Health located in Delaware PA, will be closing, which includes Crozer-Chester Medical Center and Taylor Hospital. In the last year 4,600 Highmark Commercial and Medicare members have used services at Crozer Health. Members who used any services from Crozer health in the last year will be notified and be assisted in helping finding providers and facilities. Through logging in on the member portal online or the MyHighmark app members can find alternative in-network doctors. The 2025 Agent Field Guide is a comprehensive resource for doing business with Highmark, covering technical processes, commissions, compliance, agent oversight, and detailed product information for MA, D-SNP, and ACA lines of business.… Read More

Aetna CVS Health will exit the ACA Marketplace, as of December 31,2025

May 6, 2025May 6, 2025Loramei Romeo

There has been an important update about ACA customers coverage. Aetna CVS Health has decided to exit the Individual and Family Plan business, as of December 31,2025. There will be no change to customer’s current plan for 2025. Therefore, you can count on the same service you have today for the rest of 2025. By July 1,2025, you will receive a letter from Aetna CVS Health with more information and next steps. During the fall Open Enrollment season, members will need to choose a new health insurance plan with a different company to be covered in 2026. We are dedicated to providing exceptional service, so please do not hesitate to… Read More

Small Shifts, Big Impact: Simple Strategies to Elevate Your Overall Well-Being

May 5, 2025May 1, 2025Loramei Romeo

Feeling your best—inside and out—doesn’t always require a drastic overhaul. Sometimes, the smallest shifts in daily habits can yield the biggest results. The goal isn’t to chase perfection but rather to create a sustainable routine that fosters both physical and mental wellness. From the way you start your mornings to ensuring you have the right safety nets in place, every choice you make contributes to your overall well-being. Here are a few simple yet powerful strategies to help you feel more energized, balanced, and at peace with yourself. Begin Your Day with Purpose Mornings set the tone for the rest of your day, and a chaotic start can leave you… Read More

Benefits 101 Comparison HSAs HRAs FSAs

April 4, 2025April 3, 2025Loramei Romeo

Have Questions? and want to read more about the changes click HSA FSA HRA Comparison Chart for more details. 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.

Recent Lawsuits Face Scrutiny for Tobacco Surcharges

March 21, 2025March 20, 2025Loramei Romeo

Recently, there has been an increase in class action lawsuits targeting large group health plan sponsors. These lawsuits claim that the extra insurance premiums charged to tobacco users, known as “tobacco surcharges,” through wellness programs violate HIPAA nondiscrimination rules. This litigation serves as a reminder for employers to thoroughly review their plan designs to ensure compliance with these regulations. Below is a summary of the plaintiffs’ arguments and some key considerations for employers when implementing tobacco-related incentives. Have Questions? and want to read more about the changes click Tobacco Surcharges Face Growing Scrutiny in Recent Lawsuits for more details. We are dedicated to providing exceptional service, so please do not hesitate… Read More

Premium Only Plan Document (POP) Section 125

February 7, 2025February 6, 2025Loramei Romeo

What is a Section 125 Premium Only Plan?The Revenue Act of 1978 introduce IRS Section 125, which allows employers to reduce payroll taxes by adjusting the payroll process. Also, Section 125 Premium Only Plan employees can choose from pre-tax or tax-free basis pay for their portion of premium insurance rather than after-tax basis, which creates saving for both the employer and employee. How Employees Benefit from a Premium Only Plan.Section 125 premium deductions can save employees 20 or 40% of their pre-tax. The tax savings are on city, state, and federal income taxes, including Social Security and Medicare taxes on money used to pay for their portion of insurance premiums… Read More

Horizon and Braven Health Prescription Drug Benefits

January 27, 2025January 27, 2025Loramei Romeo

IMPORTANT NOTICE: Horizon and Braven Health Prescription Drug Benefits GLP-1 medications like Ozempic and Mounjaro are covered by the prescription drug benefits of Horizon Medicare Blue Rx (PDP) and Braven Health Medicare Advantage plans. GLP-1 medications are used to treat obesity and type 2 diabetes. Medicare, however, only covers these medications for diabetes. Prior authorization is also required for GLP-1 medications. This implies that before we agree to cover the medication, the member or their practitioner must obtain plan approval. To guarantee pharmaceutical safety and assist in directing the proper use of specific medications, prior permission is implemented. The medication may not be covered by the plan if the member DOES… Read More

Important Update Regarding the Distribution of Form 1095-B for Tax Year 2024

January 24, 2025January 24, 2025Loramei Romeo

Horizon BCBSNJ is constantly searching for methods to make working with us more convenient and easier. For this reason, Horizon has modified the way they provide Form 1095-B to their members who are fully insured this year. What is Form 1095-B?The names, residences, Social Security numbers, and number of months that each member of a fully insured health plan was covered from January 1 to December 31 of each calendar year are reported on Form 1095-B. Form 1095-B is explained in greater detail here. How Is Distribution Changing This Year? In previous years, Form 1095-B was sent by mail to all subscribers enrolled in a Horizon fully insured plan. However,… Read More

Changes for Prescription Drug Coverage

January 7, 2025Loramei Romeo

SJRA and Larchmont Facilities returns to Horizon’s Network

January 3, 2025January 3, 2025Loramei Romeo

South Jersey Radiology Associates (SJRA) which includes Larchmont Medical Imaging has made an agreement with Horizon BCBSNJ. On January 1, 2025, they will return to the network. *SJRA services are regarded as out of network if they are provided between April 1, 2024, and December 31, 2024. There will be no retroactive processing of claims. 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.

Independence – Update regarding ID Cards for January 1st IBX Customers

January 2, 2025January 2, 2025Loramei Romeo

The IBX Team has provided us the following update regarding ID Cards for January 1st Customers. Due to the large volume of cards being processed and mailed for January, members may not receive their physical ID cards before January 1. To ensure uninterrupted access to care for members with ID cards processing in the second half of December, letters are being mailed to plan subscribers containing their new member ID numbers and ID numbers for all covered dependents. The sample letter is attached, and it’s important to note these members can access their ID cards on the portal until they receive the physical card. We’re just trying to be proactive… Read More

Changes for Prescription Drug Coverage

December 27, 2024December 27, 2024Loramei Romeo

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.

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this: