Stephanie Spancake Total Benefit Solutions Inc

Beyond Sick Leave: Integrating HRAs and Group Health

Ed MacConnellNo Comments

Beyond Sick Leave: Integrating HRAs and Group Health Managing mandatory sick leave is just one piece of the employee retention puzzle. At Total Benefit Solutions Inc, we believe in a holistic approach. If you’re already paying for mandatory sick leave, you might be looking for ways to balance your budget elsewhere without sacrificing the quality of your benefits. This is where Health Reimbursement Arrangements (HRAs) come into play. HRAs allow employers to reimburse employees for medical expenses (and sometimes premiums) tax-free. They are an excellent tool for small to mid-sized businesses navigating the PA sick leave patchwork. HRA Plan Design Options for 2026: Section 105 HRA (For 1 Employee or… Read More

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Medicare Secondary Payer Rules

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

Ed MacConnell

So, your business is growing, your team is aging like a fine wine, and suddenly, you’ve got employees hitting that magical number: 65. Congratulations! You’ve reached the level of the “Medicare Secondary Payer” (MSP) boss fight. If that sounds intimidating, it’s because it can be. Medicare Secondary Payer rules are essentially the government’s way of saying, “We aren’t paying for this if someone else can.” At Total Benefit Solutions Inc, we spend our days navigating these regulatory minefields so you don’t have to step on a $1,000-per-claim landmine. Whether you’re offering group health insurance for employers or looking into affordable group health insurance options, understanding MSP is non-negotiable. Here are… Read More

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Member of American Association of Medicare Supplements

Total Benefit Solutions is Now an Official Member of the American Association for Medicare Supplement Insurance

Lily Dalton

We’re proud to announce that Total Benefit Solutions is now an official member of the American Association for Medicare Supplement Insurance (AAMSI)! AAMSI is a nationally recognized organization dedicated to supporting professionals who specialize in Medicare and Medicare Supplement insurance. Their mission is to promote education, ethical standards, and consumer awareness within the Medicare industry. Becoming a member of AAMSI reflects our ongoing commitment to providing trusted guidance, reliable information, and personalized support to every client we serve. As part of this respected organization, Total Benefit Solutions gains access to valuable industry resources, continued education, and up-to-date Medicare insights — helping us better serve our clients with confidence and care.… Read More

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ACA Affordabillity Ruke

The 2026 ACA Affordability Rule Explained in Under 3 Minutes

Ed MacConnell

— If you’re a business owner or an HR manager, you know that health insurance rules change faster than the weather in Philadelphia. One minute you’re settled into your 2025 plan design, and the next, the IRS drops a new percentage that changes how much you can charge your team for coverage. The 2026 ACA Affordability threshold has officially been announced, and it’s a big one. For the first time in a while, we’re seeing a significant jump in the percentage. We know you’re busy. That’s why we’ve broken down everything you need to know about affordable group health insurance requirements for 2026 in a post that takes less time… Read More

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Member of American Association of Medicare #medicare Supplements #medicaresupplements

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

Ed MacConnell

Let’s be honest: talking about Medicare Secondary Payer (MSP) rules is about as exciting as watching paint dry in a room full of accountants. But here’s the kicker, if you’re a small business owner, ignoring these rules is a great way to watch your hard-earned profits vanish into a black hole of federal fines. At Total Benefit Solutions Inc, we spend our days navigating the labyrinth of group health insurance for employers, and we’ve seen it all. We know that you’re just trying to provide affordable group health insurance without getting slapped by Uncle Sam. CMS (the Centers for Medicare & Medicaid Services) has a very specific sense of humor,… Read More

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How to Choose the Best Group Health Benefits for Small Business (Compared)

Ed MacConnell

Choosing the right group health insurance for employers can feel like trying to navigate a maze without a map. If you are a small business owner, you already know the stakes. Providing group health benefits for small business is one of your biggest expenses, yet it’s also your most powerful tool for attracting and keeping great employees. In 2026, the landscape of healthcare is shifting faster than ever. With median premium increases hitting double digits (often around 11% or higher), the "standard" way of doing things might not be the best way for your bottom line. We see many business owners stuck in a cycle of "renewal shock," where they… Read More

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Total Benefit Solutions

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

Ed 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

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Total Benefit Solutions #healthinsurance, #healthinsuranceNJ, #horizonbluecross, #IndividualMandate #healthinsurance, #medical #medicare #medicalplans #Medicaid #healplans #totalbenefitsolutions #employee benefits #healthinsurance, #aca, #aca, #obamacarealternatives, #cobra, #pennie, #getcoveredNJ, #medicareadvantage, #medicaresupplements, #totalbenefits #independence #bluecross, #aetna, #unitedhealthcare, #amerihealth, #nippon, #unitedconcordia, #horizon, #AmericanHealthInsurance, #aflac, #aetna, #ICHRA, #HRA, #healthreimbursement, #buckscounty, #healthinsurancenearme, #healthinusrancebuckscounty, #healthinsurancebuckscounty, #healthinsurancenearby, #healthonsurancephiladelphia, #healthinsuranceinPA, #healthinsuranceNJ, #PENNIE, #PENNIEHEALTHINSURANCE, #cobraalternatives, #turning26, #turning65, #adultinghealthinsurance, #healthinsurancenearme, #healthinsurancenearby, #healthinsurancefeasterville, #healthinsurancephilly, #bluecardppo, #minimumessentialplans, #minimumvalueplans, #shorttermhealthplan, #bluecross

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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Total Benefit Solutions #healthinsurance, #healthinsuranceNJ, #horizonbluecross, #IndividualMandate #healthinsurance, #medical #medicare #medicalplans #Medicaid #healplans #totalbenefitsolutions #employee benefits #healthinsurance, #aca, #aca, #obamacarealternatives, #cobra, #pennie, #getcoveredNJ, #medicareadvantage, #medicaresupplements, #totalbenefits #independence #bluecross, #aetna, #unitedhealthcare, #amerihealth, #nippon, #unitedconcordia, #horizon, #AmericanHealthInsurance, #aflac, #aetna, #ICHRA, #HRA, #healthreimbursement, #buckscounty, #healthinsurancenearme, #healthinusrancebuckscounty, #healthinsurancebuckscounty, #healthinsurancenearby, #healthonsurancephiladelphia, #healthinsuranceinPA, #healthinsuranceNJ, #PENNIE, #PENNIEHEALTHINSURANCE, #cobraalternatives, #turning26, #turning65, #adultinghealthinsurance, #healthinsurancenearme, #healthinsurancenearby, #healthinsurancefeasterville, #healthinsurancephilly, #bluecardppo, #minimumessentialplans, #minimumvalueplans, #shorttermhealthplan, #bluecross

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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Total Benefit Solutions #healthinsurance, #healthinsuranceNJ, #horizonbluecross, #IndividualMandate #healthinsurance, #medical #medicare #medicalplans #Medicaid #healplans #totalbenefitsolutions #employee benefits #healthinsurance, #aca, #aca, #obamacarealternatives, #cobra, #pennie, #getcoveredNJ, #medicareadvantage, #medicaresupplements, #totalbenefits #independence #bluecross, #aetna, #unitedhealthcare, #amerihealth, #nippon, #unitedconcordia, #horizon, #AmericanHealthInsurance, #aflac, #aetna, #ICHRA, #HRA, #healthreimbursement, #buckscounty, #healthinsurancenearme, #healthinusrancebuckscounty, #healthinsurancebuckscounty, #healthinsurancenearby, #healthonsurancephiladelphia, #healthinsuranceinPA, #healthinsuranceNJ, #PENNIE, #PENNIEHEALTHINSURANCE, #cobraalternatives, #turning26, #turning65, #adultinghealthinsurance, #healthinsurancenearme, #healthinsurancenearby, #healthinsurancefeasterville, #healthinsurancephilly, #bluecardppo, #minimumessentialplans, #minimumvalueplans, #shorttermhealthplan, #bluecross

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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Total Benefit Solutions #healthinsurance, #healthinsuranceNJ, #horizonbluecross, #IndividualMandate #healthinsurance, #medical #medicare #medicalplans #Medicaid #healplans #totalbenefitsolutions #employee benefits #healthinsurance, #aca, #aca, #obamacarealternatives, #cobra, #pennie, #getcoveredNJ, #medicareadvantage, #medicaresupplements, #totalbenefits #independence #bluecross, #aetna, #unitedhealthcare, #amerihealth, #nippon, #unitedconcordia, #horizon, #AmericanHealthInsurance, #aflac, #aetna, #ICHRA, #HRA, #healthreimbursement, #buckscounty, #healthinsurancenearme, #healthinusrancebuckscounty, #healthinsurancebuckscounty, #healthinsurancenearby, #healthonsurancephiladelphia, #healthinsuranceinPA, #healthinsuranceNJ, #PENNIE, #PENNIEHEALTHINSURANCE, #cobraalternatives, #turning26, #turning65, #adultinghealthinsurance, #healthinsurancenearme, #healthinsurancenearby, #healthinsurancefeasterville, #healthinsurancephilly, #bluecardppo, #minimumessentialplans, #minimumvalueplans, #shorttermhealthplan, #bluecross

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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Total Benefit Solutions #healthinsurance, #healthinsuranceNJ, #horizonbluecross, #IndividualMandate #healthinsurance, #medical #medicare #medicalplans #Medicaid #healplans #totalbenefitsolutions #employee benefits #healthinsurance, #aca, #aca, #obamacarealternatives, #cobra, #pennie, #getcoveredNJ, #medicareadvantage, #medicaresupplements, #totalbenefits #independence #bluecross, #aetna, #unitedhealthcare, #amerihealth, #nippon, #unitedconcordia, #horizon, #AmericanHealthInsurance, #aflac, #aetna, #ICHRA, #HRA, #healthreimbursement, #buckscounty, #healthinsurancenearme, #healthinusrancebuckscounty, #healthinsurancebuckscounty, #healthinsurancenearby, #healthonsurancephiladelphia, #healthinsuranceinPA, #healthinsuranceNJ, #PENNIE, #PENNIEHEALTHINSURANCE, #cobraalternatives, #turning26, #turning65, #adultinghealthinsurance, #healthinsurancenearme, #healthinsurancenearby, #healthinsurancefeasterville, #healthinsurancephilly, #bluecardppo, #minimumessentialplans, #minimumvalueplans, #shorttermhealthplan, #bluecross

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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Total Benefit Solutions #healthinsurance, #healthinsuranceNJ, #horizonbluecross, #IndividualMandate #healthinsurance, #medical #medicare #medicalplans #Medicaid #healplans #totalbenefitsolutions #employee benefits #healthinsurance, #aca, #aca, #obamacarealternatives, #cobra, #pennie, #getcoveredNJ, #medicareadvantage, #medicaresupplements, #totalbenefits #independence #bluecross, #aetna, #unitedhealthcare, #amerihealth, #nippon, #unitedconcordia, #horizon, #AmericanHealthInsurance, #aflac, #aetna, #ICHRA, #HRA, #healthreimbursement, #buckscounty, #healthinsurancenearme, #healthinusrancebuckscounty, #healthinsurancebuckscounty, #healthinsurancenearby, #healthonsurancephiladelphia, #healthinsuranceinPA, #healthinsuranceNJ, #PENNIE, #PENNIEHEALTHINSURANCE, #cobraalternatives, #turning26, #turning65, #adultinghealthinsurance, #healthinsurancenearme, #healthinsurancenearby, #healthinsurancefeasterville, #healthinsurancephilly, #bluecardppo, #minimumessentialplans, #minimumvalueplans, #shorttermhealthplan, #bluecross

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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Total Benefit Solutions #healthinsurance, #healthinsuranceNJ, #horizonbluecross, #IndividualMandate #healthinsurance, #medical #medicare #medicalplans #Medicaid #healplans #totalbenefitsolutions #employee benefits #healthinsurance, #aca, #aca, #obamacarealternatives, #cobra, #pennie, #getcoveredNJ, #medicareadvantage, #medicaresupplements, #totalbenefits #independence #bluecross, #aetna, #unitedhealthcare, #amerihealth, #nippon, #unitedconcordia, #horizon, #AmericanHealthInsurance, #aflac, #aetna, #ICHRA, #HRA, #healthreimbursement, #buckscounty, #healthinsurancenearme, #healthinusrancebuckscounty, #healthinsurancebuckscounty, #healthinsurancenearby, #healthonsurancephiladelphia, #healthinsuranceinPA, #healthinsuranceNJ, #PENNIE, #PENNIEHEALTHINSURANCE, #cobraalternatives, #turning26, #turning65, #adultinghealthinsurance, #healthinsurancenearme, #healthinsurancenearby, #healthinsurancefeasterville, #healthinsurancephilly, #bluecardppo, #minimumessentialplans, #minimumvalueplans, #shorttermhealthplan, #bluecross

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

Lily 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

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Total Benefit Solutions #healthinsurance, #healthinsuranceNJ, #horizonbluecross, #IndividualMandate #healthinsurance, #medical #medicare #medicalplans #Medicaid #healplans #totalbenefitsolutions #employee benefits #healthinsurance, #aca, #aca, #obamacarealternatives, #cobra, #pennie, #getcoveredNJ, #medicareadvantage, #medicaresupplements, #totalbenefits #independence #bluecross, #aetna, #unitedhealthcare, #amerihealth, #nippon, #unitedconcordia, #horizon, #AmericanHealthInsurance, #aflac, #aetna, #ICHRA, #HRA, #healthreimbursement, #buckscounty, #healthinsurancenearme, #healthinusrancebuckscounty, #healthinsurancebuckscounty, #healthinsurancenearby, #healthonsurancephiladelphia, #healthinsuranceinPA, #healthinsuranceNJ, #PENNIE, #PENNIEHEALTHINSURANCE, #cobraalternatives, #turning26, #turning65, #adultinghealthinsurance, #healthinsurancenearme, #healthinsurancenearby, #healthinsurancefeasterville, #healthinsurancephilly, #bluecardppo, #minimumessentialplans, #minimumvalueplans, #shorttermhealthplan, #bluecross

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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