Is Your Insurance Carrier Hiding Money? The Blue Cross Lawsuit Every Employer Needs to Know About

Ed MacConnellNo Comments

For years, the health insurance industry has operated behind a veil of complexity that would make a magician blush. But a massive legal bombshell was recently dropped that suggests some of that "complexity" might actually be a cover for something far more calculated: hidden profits at the expense of American employers. A high-stakes class-action lawsuit has been filed against Blue Cross Blue Shield of Texas (BCBSTX), and it’s a case that every business owner, HR director, and CFO needs to pay attention to right now. This isn't just another legal squabble over paperwork; it’s a direct challenge to how insurance carriers handle your money, specifically, the massive "hidden" rebates they… Read More

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Why Your HR Team Will Love Remodel Health (And Why We Chose Them)

Ed MacConnellNo Comments

For years, we’ve watched human resources managers and business owners dread "The Renewal." You know the feeling: that thick envelope arrives from your carrier, usually containing a 15% or 20% rate increase, and you’re left with two bad choices. You either pass the cost onto your employees or you slash benefits to keep the budget under control. It is a losing game that leaves everyone frustrated. At Total Benefit Solutions Inc., we believe there is a better way to do business. We’ve always been committed to never accepting "no" as an answer (a core philosophy we call our advocacy approach) and that means searching for tools that actually solve the… Read More

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Group of One, Real Coverage: What Sole Proprietors Are Missing in 2026

Ed MacConnellNo Comments

If you are a freelancer, consultant, independent contractor, gig worker, or sole proprietor, health insurance can feel like a business problem with only one answer: buy an individual ACA plan and hope it fits. That assumption is understandable: but incomplete. Your coverage options depend on more than whether you work for yourself. They also depend on your business structure, whether you have common-law employees (workers you control and pay as employees), your state’s insurance rules, your household income, your prescriptions, your dependents, and whether you plan to hire. In 2026, the right strategy is not simply finding the lowest monthly premium. It is comparing your total exposure: premiums, deductibles, out-of-pocket… Read More

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Is Your Health Insurance Plan Stuck in the 90s? Meet the Modern Solution

Ed MacConnell

If you are still managing your company’s health insurance using a traditional "one-size-fits-all" group plan, you might as well be using a dial-up modem to run your business. The world has changed, but for many small to medium-sized businesses (SMBs), the way they buy health insurance is stuck in a different era. You know the routine. Every year, you receive a renewal notice with a double-digit price increase, and you’re forced to choose between higher premiums or worse coverage for your team. It is a cycle of frustration that leaves you with a predictable budget (predictably high, that is) and leaves your employees with a plan they didn't choose and… Read More

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Total Benefit Solutions Inc. Partners with Remodel Health: A New Era of Health Benefit Advocacy

Ed MacConnell

At Total Benefit Solutions Inc., we have spent decades serving as a lighthouse in the often-foggy world of health insurance. Our mission has always been simple: to act as your tireless advocate, navigating the complex rules of state and federal programs to ensure you get the benefits you deserve. We’ve built our reputation on a personalized approach and a refusal to ever accept "no" as an answer when fighting for our clients. Today, we are thrilled to announce a significant evolution in our ability to serve you. Total Benefit Solutions Inc. has officially entered into an agreement to represent Remodel Health, a pioneer in modern health benefit technology. By becoming… Read More

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You Can’t Enroll in October , But Your Health Problems Don’t Wait Either

Ed MacConnell

It’s a Tuesday morning in mid-October. You’ve finally found a moment to sit down and tackle that "to-do" list that’s been staring you in the face for months. At the very top, circled in red, are the words: "Sort out health insurance." You head over to the official sites, maybe click around a few marketplace portals, and then you see it, the digital equivalent of a "Closed" sign. The bold text informs you that Open Enrollment doesn't actually begin until November 1st, and even then, your coverage won't start until January 1st. A cold knot forms in your stomach. You’re a freelancer, a gig worker, or a small business owner.… Read More

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Can an ICHRA Be Used to Pay Medicare Premiums? What Employers Need to Know

Ed MacConnell

As an employer or business owner, designing a competitive health benefits package while accommodating employees of varying ages can feel like walking through a regulatory minefield. One of the most common questions we hear at Total Benefit Solutions Inc. from employers looking to modernize their benefits strategy is: Can an Individual Coverage Health Reimbursement Arrangement (ICHRA) be used to pay Medicare premiums? The short answer is yes. When structured correctly under federal guidelines, an ICHRA can reimburse Medicare premiums on a tax-advantaged basis, offering incredible flexibility for both your business and your Medicare-eligible staff (including older workers transitioning to retirement or business owners remaining active past age 65). However, navigating… Read More

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The 30% Hammer: What to Do When Your Health Insurance Renewal is a Disaster

Ed MacConnell

It happens every year, but this July feels different. You open the envelope from your health insurance carrier, expecting the usual 5% or 8% “cost of living” increase. Instead, you’re hit with a number that feels like a physical blow: a 30% premium hike. If this sounds familiar, you aren’t alone. Recent data from July 2026 shows that 1 in 5 small businesses across the country are facing renewal increases of 30% or more. For a company with ten employees, that isn’t just a budget adjustment, it’s a threat to your ability to hire, grow, or even stay in business. At Total Benefit Solutions Inc, we call this “The 30%… Read More

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Arizona’s New Health Insurance ‘Gold Rush’: Why Sole Proprietors No Longer Have to Go It Alone

Ed MacConnell

For years, if you were a sole proprietor or a "group of one" in Arizona, your health insurance options were often frustratingly limited. You were stuck between the individual marketplace, where costs can skyrocket and networks can feel narrow, or going without coverage altogether. But as of July 2026, the landscape of Arizona healthcare has fundamentally shifted. A new law, Arizona House Bill 2693 (HB 2693), has officially taken effect, and it is being hailed by industry experts as a "Gold Rush" for entrepreneurs, gig workers, and small business owners across the Grand Canyon State. At Total Benefit Solutions Inc, we’ve been tracking this legislation closely because it represents one… Read More

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The 2027 Open Enrollment Patchwork: Tracking Deadlines in PA, NJ, and AZ

Ed MacConnell

If you feel like the rules for health insurance are changing faster than the seasons, you aren’t alone. For the 2027 plan year, we have witnessed a significant "regulatory whiplash" that has left many individuals and business owners scrambling to update their calendars. At Total Benefit Solutions Inc, we have been tracking these developments closely to ensure our clients are never caught off guard by a shifting deadline. The headlines for the upcoming 2027 Open Enrollment (OE) season have been dominated by a legal tug-of-war. What was originally planned as a shortened, more restrictive enrollment period has been largely overturned by a recent lawsuit. This means that for many of… Read More

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The ‘I’m Too Young for Insurance’ Tax: What Happens When You Skip Coverage

Ed MacConnell

Let’s be real for a second. You’re 26, 28, maybe 32. You’re finally finding your rhythm as a freelancer or gig worker. You hit the gym three times a week, you drink your greens, and the last time you saw a doctor was for a physical three years ago. When you look at your monthly budget, that $300 or $400 health insurance premium feels like a total scam. It’s money disappearing into a black hole for a "what if" that feels a lifetime away. So, you decide to "go naked" (industry speak for uninsured). You figure you’ll just pay out of pocket if you get a cold. But here’s the… Read More

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ACA Controlled Group Penalties: What Happens When the IRS Finds Out You’re an ALE

Ed MacConnell

You manage your business with precision. You know your payroll numbers, your overhead, and your staff count. You have 35 full-time employees, which, in your mind, keeps you safely under the 50-employee threshold for the Affordable Care Act (ACA) Employer Mandate. You aren't an "Applicable Large Employer" (ALE), so you don't think you need to worry about offering group health insurance for employers or filing complex IRS forms. But what if you also own 85% of a secondary boutique firm with 20 employees? Or what if you and your two business partners own three different LLCs, each with 18 employees? Suddenly, the IRS doesn't see three small businesses. They see… Read More

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Pennie’s 2027 Open Enrollment Shift: You Just Got More Time (But Don’t Waste It)

Ed MacConnell

If you have been keeping a close eye on the calendar for your 2027 health insurance planning, you probably noticed some conflicting information recently. For months, the buzz around Pennsylvania’s state-based exchange, Pennie, suggested that the Open Enrollment window was going to be significantly shorter than in previous years. However, we have some major news that will change how you approach your year-end planning. Pennie has officially reverted to its original, extended Open Enrollment dates. While many expected a condensed window, you now have until mid-January to finalize your coverage for the 2027 plan year. At Total Benefit Solutions Inc, we make it our mission to stay on top of… Read More

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Do You Own Multiple Businesses? The ACA Controlled Group Trap That Could Cost You

Ed MacConnell

If you’re an entrepreneur with your hands in several different pots, you probably feel like you’ve mastered the art of the "small" business. You might own a local restaurant, a residential cleaning company, and a boutique retail shop. In your mind, these are three separate entities with three separate payrolls. Because each business employs fewer than 50 people, you likely believe you are exempt from the Affordable Care Act (ACA) employer mandate. You might think that group health insurance for employers is a choice, not a requirement, for your specific situation. However, there is a technicality in the tax code that the IRS uses to "aggregate" your employees across all… Read More

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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 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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PCORI Fee Due July 31: Small Biz Owners, Don’t Forget This Hidden Tax on Your HRA

Ed MacConnell

If you are a small business owner offering health benefits, you likely feel like you’ve finally mastered the basics. You’ve picked a plan, you’re managing premiums, and your team is covered. But then, a cryptic acronym like "PCORI" pops up on your radar, accompanied by an IRS deadline. The Patient-Centered Outcomes Research Institute (PCORI) fee is one of those "hidden" requirements from the Affordable Care Act (ACA). While it might seem like a small administrative hurdle, missing the July 31 deadline can lead to unnecessary headaches with the IRS. If you manage a Health Reimbursement Arrangement (HRA) or an Individual Coverage HRA (ICHRA), the responsibility for this fee falls squarely… Read More

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

Ed 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

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

Ed 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

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

Ed 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

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Can AI Stop You From Picking the Wrong Health Plan?

Ed MacConnell

Open Enrollment is often the most stressful time of the year for both employers and employees. It is a period defined by dense paperwork, confusing jargon, and the high-stakes pressure of choosing the right safety net for the next twelve months. Despite the annual ritual, we aren't getting any better at it. Recent industry data reveals a staggering reality: 35% of employees regret their health insurance choices once the enrollment window closes. (This "regret factor" often stems from realizing a preferred doctor is out-of-network or that out-of-pocket costs are higher than anticipated.) As we move into 2026, many businesses are looking to Artificial Intelligence (AI) to solve this problem. If… Read More

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

Ed 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

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