Category: AARP Medicare

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

Continue Reading

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

Continue Reading

If you're managing benefits for a company with 50-200 employees, dental insurance is probably on your radar: but it might be lower on your priority list than medical coverage. That's a mistake. Here's the reality: dental benefits are one of the most used (and most appreciated) employee benefits you can offer. Employees actually see their dentist twice a year for cleanings, and when they need a filling or root canal, they're reminded exactly how much value that dental plan provides. At Total Benefit Solutions, we've seen firsthand how the right dental plan can boost retention, keep your team healthy, and avoid the nightmare scenario of someone calling out for a… Read More

Continue Reading

If you're a mid-sized employer shopping for affordable group health insurance, you've probably been told that dental coverage is a "nice-to-have" add-on. That's dead wrong. At Total Benefit Solutions, we've spent three decades proving that preventive dental plans aren't just employee perks, they're one of the smartest cost-containment strategies you can deploy. The data is clear: employers who invest in strong preventive dental benefits save thousands per employee over time, reduce absenteeism, and stop hemorrhaging money on emergency procedures that should never have happened in the first place. Here's why we push every client to take dental seriously, and how the numbers prove we're right. The Guardian Life Study: The… Read More

Continue Reading

If you're running a small business and watching your best employees walk out the door for "better benefits," there's a good chance you're missing one of the simplest retention tools in the book: dental insurance. I know what you're thinking. "Ed, we're a small shop. We can barely afford medical insurance. How are we supposed to add dental?" That's exactly the conversation I have with business owners every week, and here's what I tell them: You can't afford NOT to offer it. At Total Benefit Solutions, we don't accept the tired excuses carriers and administrators throw at small businesses. We fight for affordable group health insurance packages that actually work,… Read More

Continue Reading

Here's something most small business owners don't realize when they're cutting costs on group health benefits: dental coverage isn't just about preventing cavities. It's one of the most effective early warning systems for serious medical conditions like diabetes, heart disease, and oral cancer. At Total Benefit Solutions, we've spent three decades fighting for employers who deserve better than "bare minimum" benefits packages. And we've learned that dental insurance isn't a "nice-to-have" perk: it's a strategic health investment that catches expensive medical problems before they explode your claims and sideline your workforce. Why Your Dentist Sees More Than Your Doctor Does The average American visits their dentist twice a year but… Read More

Continue Reading

Picture this: One of your employees gets a diagnosis, jaw tumor, severe infection requiring hospitalization, or a traumatic injury that shatters three teeth and damages the bone. The oral surgeon says surgery is medically necessary. Your employee submits the claim. And then the insurance carrier sends back a denial letter with some version of "dental procedures aren't covered under your medical plan." At Total Benefit Solutions, that's where the real work begins. Because we don't accept "no" when "no" means your employee is stuck with a $15,000 bill for a surgery that should have been covered. The Dental Coverage Shell Game Insurance carriers have perfected the art of passing the… Read More

Continue Reading

Let's cut through the noise. Reference based pricing (RBP) is exactly what it sounds like: you pay healthcare providers based on a reference point: typically a percentage above Medicare rates: instead of whatever inflated number a traditional PPO network negotiates (or doesn't negotiate). It's not for everyone. But if you're tired of watching premiums climb 8-12% every year while carriers shrug and say "that's just how it is," RBP might be the shake-up your group needs. How Reference Based Pricing Actually Works Here's the traditional PPO model: insurance carriers negotiate "discounts" with provider networks. A hospital charges $50,000 for a surgery. The carrier "negotiates" it down to $40,000 and calls… Read More

Continue Reading

Here's something most small business owners don't know: there's a type of group health insurance for employers that can actually write you a check at the end of the year. Not a bill. A refund. Sounds too good to be true, right? But it's not some gimmick or marketing trick. It's called level funding, and it's one of the smartest moves a small to mid-sized business can make when traditional health insurance premiums keep climbing year after year. Let me explain how this works, and whether your business should be taking advantage of it. What Is Level Funding (And Why Don't More People Know About It)? Level funding sits right… Read More

Continue Reading

Let's be real: traditional group health insurance for employers feels like you're throwing money into a black hole every year. Premiums keep climbing (hello, 2026 rate increases), you have zero visibility into where your dollars are actually going, and you're basically betting that your insurance carrier knows your business better than you do. Spoiler alert: they don't. If you're tired of watching your health insurance costs spiral while getting nothing but vague explanations from your carrier, it's time to look at level funding. It's the insurance model that gives small business owners what they've been begging for: transparency, control, and the possibility of actually getting money back at the end… Read More

Continue Reading

If you're a small to mid-sized business owner looking at your 2026 health insurance renewal and feeling that familiar sinking feeling in your stomach, you're not alone. Traditional fully insured premiums are climbing yet again, and many employers are searching for alternatives that won't break the bank. Enter level funding, a hybrid approach that's gaining serious traction among businesses with 10-100 employees. But here's the thing: level funding isn't just about lower monthly payments. It comes with its own set of compliance obligations that you absolutely need to understand before making the switch. What Is Level Funding, Anyway? Think of level funding as the "Goldilocks" option for group health insurance… Read More

Continue Reading

If you're a small business owner, you've probably noticed that your group health insurance for employers keeps getting more expensive every year. The 2026 renewals are already showing premium increases that'll make your accountant cringe. But here's something most business owners don't know: you're not stuck choosing between sky-high premiums and dropping coverage altogether. Level funding is the middle ground that's been saving small businesses thousands of dollars: and it's time more employers knew about it. What Exactly Is Level Funding? Think of level funding as the "Goldilocks" of health insurance. It's not fully insured (where you pay fixed premiums and the insurance company takes all the risk), and it's… Read More

Continue Reading

If you're an employer with Medicare-eligible employees on your group health plan : or you're an employee trying to figure out whether to drop your employer coverage once you hit 65 : you need to understand Medicare Secondary Payer (MSP) rules. These rules determine which insurance pays first when someone has both Medicare and employer-sponsored coverage. Get it wrong, and you could face claim denials, surprise bills, or even compliance penalties. Let's break it down in plain English. What Are Medicare Secondary Payer Rules? Medicare Secondary Payer rules determine the order in which insurance plans pay when someone has both Medicare and other coverage (like group health insurance from an… Read More

Continue Reading

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

Continue Reading

Let's be real: group health insurance for employers isn't cheap. And if you're running a small or mid-sized business, every dollar counts. The frustrating part? Many business owners are overspending on their group health benefits without even realizing it. The good news is that most of these costly mistakes are completely fixable. You just need to know what to look for. We've helped countless employers find affordable group health insurance that actually works for their teams and their budgets. Along the way, we've spotted the same mistakes popping up again and again. Here are the seven biggest ones: and exactly how to fix them. Mistake #1: Choosing a Plan Based… Read More

Continue Reading

If you're an employer offering group health benefits, or an employee trying to figure out how your coverage works alongside Medicare, the Medicare Secondary Payer (MSP) rules are something you absolutely need to understand. And with 2026 shaping up to be a major enforcement year, now's the time to get your compliance ducks in a row. Let's break down what the medicare secondary payer rules actually mean, when Medicare pays second, and what you need to do to stay on the right side of the regulations this year. What Are Medicare Secondary Payer Rules? Here's the deal: Medicare doesn't always pay first for your healthcare costs. In certain situations, another… Read More

Continue Reading

Running a small business means wearing a dozen hats, and figuring out affordable group health insurance shouldn't require a PhD in healthcare policy. Yet here you are, trying to attract top talent while keeping your budget intact. Good news: group health benefits for small business owners are more accessible than you might think. Whether you've got two employees or twenty, there are options that won't drain your bank account. Let's break down the ten essential things you need to know before making this critical decision. 1. You Don't Need a Big Team to Qualify Here's something that surprises a lot of small business owners: group health insurance typically requires just… Read More

Continue Reading

Let's cut right to it: if you're an employer offering group health insurance, compliance isn't optional. It's not a "nice to have." It's the law. And in 2026, the requirements are more detailed: and the deadlines more numerous: than ever before. We get it. You're busy running a business. The last thing you want to think about is a mountain of IRS forms, federal attestations, and employee notices. But here's the truth: ignoring group health plans requirements can cost you big time. We're talking fines, penalties, and potential legal headaches that no business owner wants to deal with. So does group health plan compliance really matter in 2026? Absolutely. Let's… Read More

Continue Reading

If you've ever shopped for health insurance, you've probably come across the term "Minimum Essential Coverage" or MEC. It sounds official. Maybe even a little intimidating. But here's the thing, it's actually a pretty straightforward concept once you break it down. Let's cut through the jargon and talk about what MEC actually is, why it matters in 2026, and how it affects you whether you're an individual looking for coverage or an employer trying to do right by your team. So, What Exactly Is Minimum Essential Coverage? Minimum Essential Coverage is any health insurance plan that meets the requirements set by the Affordable Care Act (ACA). Back when the ACA… Read More

Continue Reading