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

Ed MacConnellNo Comments

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 MacConnellNo Comments

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 MacConnellNo Comments

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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2027 HSA Limits Are Here: What You Need to Know About New Contribution, Deductible & Out-of-Pocket Caps

Ed MacConnell

The Internal Revenue Service (IRS) has officially released the inflation-adjusted limits for Health Savings Accounts (HSAs) and High Deductible Health Plans (HDHPs) for the 2027 calendar year. These updates, detailed in Revenue Procedure 2026-24, reflect the ongoing economic shifts and provide individuals and employers with the necessary benchmarks to plan their benefits strategy for the upcoming year. At Total Benefit Solutions Inc, we know that navigating the nuances of IRS regulations can feel like a full-time job. Whether you are a small business owner looking to optimize your employee benefits package or an individual trying to maximize your tax-advantaged savings, understanding these new caps is the first step toward financial… Read More

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Stephanie Spancake Total Benefit Solutions Inc

Beyond Sick Leave: Integrating HRAs and Group Health

Ed MacConnell

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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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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Hoop-Jumping for Health: The New ACA Rules Coming in 2027

Ed MacConnell

Just when you thought you had a handle on your health insurance, the rules are changing again. If you’ve been following the news lately, you might have heard that the Centers for Medicare & Medicaid Services (CMS) is rolling out some significant updates for the ACA Marketplace (the federal exchange where you buy individual health plans). These changes aren't hitting the ground until plan year 2027, but at Total Benefit Solutions Inc, we believe in staying ahead of the curve. While these new rules are designed to protect you from fraud and unauthorized plan switches, they do add a few more "hoops" for you to jump through during the enrollment… Read More

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Main Line Health vs. UnitedHealthcare: Will You Lose Your Doctor on July 1st?

Ed MacConnell

If you live in the Philadelphia suburbs, you probably know Main Line Health (MLH) as the backbone of local healthcare. From Lankenau Medical Center to Paoli Hospital, their physicians and facilities have been staples in our community for decades. However, a major contract dispute with UnitedHealthcare (UHC) is threatening to disrupt care for thousands of families. As of right now, the clock is ticking toward a June 30, 2026, deadline. If a new agreement isn’t reached by then, Main Line Health will officially become an out-of-network provider for most UnitedHealthcare commercial and Medicare Advantage plans starting July 1st. At Total Benefit Solutions Inc., we’ve seen these "carrier vs. provider" battles… Read More

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Total Benefit Solutions Inc Medicare Vaccines

Are You Paying for Vaccines You Should Get for Free?

Ed MacConnell

If you have ever walked into a pharmacy or a doctor’s office expecting a "covered" benefit only to be hit with a $200 bill at the register, you know the sinking feeling of healthcare sticker shock. For years, Medicare beneficiaries faced a confusing maze of costs when it came to staying protected against common illnesses. Some shots were free, some were expensive, and some depended entirely on where you got them. We have some good news for you. As of 2026, the landscape has shifted dramatically in your favor. Thanks to recent legislative changes, most of the vaccines you need to stay healthy are now available with a $0 out-of-pocket… Read More

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Is Your Insurance Carrier Gaslighting You? 3 Red Flags That Your “Advocate” is Actually a Salesperson

Ed MacConnell

If you’ve ever hung up the phone with your insurance carrier feeling more confused, frustrated, and somehow guilty for asking about a claim denial, you’ve likely been gaslit. In the world of group health insurance for employers, carriers have started offering a shiny new "benefit": the in-house advocate. They promise to help your employees navigate the system, find the best care, and resolve issues. On paper, it sounds like a dream. In reality, it’s often the fox guarding the henhouse. At Total Benefit Solutions Inc, we see this play out every single day. We’ve built our reputation on a simple, non-negotiable philosophy: Never Accept No. But when your "advocate" is… Read More

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The 2027 Medicare Squeeze: The $2,200 Cap and the ‘Hidden’ Benefit Cut You Need to Hear About

Ed MacConnell

If you’ve been following the news about Medicare Part D, you’ve probably heard a lot of cheering about the new out-of-pocket caps. First, it was the big $2,000 "cliff" in 2025. Then, we saw it tick up to $2,100 for 2026. But here’s the reality: Medicare is a moving target. For 2027, that cap is projected to hit $2,200. While a cap on drug costs sounds like a win across the board, the government (CMS) isn't exactly giving away free lunches. There’s a "squeeze" happening behind the scenes that most seniors won't notice until their 2027 renewal notice hits the mailbox in October 2026. At Total Benefit Solutions Inc, we… 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 Ozempic Odyssey: Navigating Medicare Coverage Without the Headache

Ed MacConnell

If you’ve turned on a television or scrolled through social media lately, you’ve heard the names: Ozempic, Wegovy, Zepbound. These GLP-1 medications have completely transformed the conversation around weight management and chronic disease. But for those of us on Medicare, the conversation has often been a short one: "No, Medicare doesn't cover weight loss drugs." For years, that 2003 federal law (the Medicare Modernization Act) has acted like a brick wall, explicitly banning coverage for medications used solely for weight loss. At Total Benefit Solutions Inc, we don't like the word "no." Neither does our resident expert, Dr. Ben E. Fitz. Today, we’re breaking down the complex odyssey of Medicare… Read More

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Blue Card PPO

Why Everyone Is Talking About Blue Card PPO (And Why Your Remote Team Needs It)

Ed MacConnell

If you’re a small business owner or an HR manager in 2026, you’ve likely noticed that the traditional office is a thing of the past. Your lead developer might be coding from a cabin in Colorado, while your head of marketing is based in a suburban home in Pennsylvania. While this geographic flexibility is a huge win for talent retention, it often creates a massive headache when it comes to group health insurance for employers. How do you provide a health plan that works just as well for someone in rural Montana as it does for someone in downtown Philadelphia? The answer that more and more savvy businesses are turning… 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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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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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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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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