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 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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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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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, unless, of course, that paint is actually a fine from the federal government. For small business owners and HR managers, these rules are the "hidden traps" of the health insurance world. One wrong move, and suddenly your "affordable group health insurance" plan is facing claw-backs, penalties, and a very grumpy group of employees. At Total Benefit Solutions Inc, we spend our days navigating these bureaucratic mazes so you don’t have to. We’re the advocates who never take "no" for an answer, especially when it comes to protecting your business from avoidable compliance… 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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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, if that paint were also trying to fine you thousands of dollars. But if you’re a small business owner or an HR manager, ignoring these rules is like playing a high-stakes game of poker where the dealer is the federal government and they’ve already seen your hand. Medicare is a bit like that friend who always "forgets" their wallet when the check comes. They’re happy to help, but only after everyone else has chipped in first. Knowing when Medicare pays first (primary) and when they pay second (secondary) isn’t just a matter… 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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The $110-a-Day Mistake: Why Your Insurance Certificate Isn’t Enough

Ed MacConnell

If you are a small business owner offering group health insurance for employers, you likely take pride in providing benefits that protect your team. You probably have a folder, digital or physical, filled with shiny brochures from your insurance carrier, a "Certificate of Coverage," and perhaps a Summary of Benefits and Coverage (SBC). You might think, "I have my documents. I’m compliant." Unfortunately, that belief is a common misconception that could cost your business thousands of dollars. In the world of federal regulation, there is a massive gap between what the insurance company provides and what the law requires you, the employer, to provide. This gap is known as the… 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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Dr Ben E Fitz

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

Ed MacConnell

Let’s be honest: nobody wakes up on a Tuesday morning and thinks, “I can’t wait to dive into the federal Medicare Secondary Payer (MSP) statutes!” Unless, of course, you work here at Total Benefit Solutions Inc. For the rest of the sane world, MSP rules are about as exciting as watching paint dry, until you get hit with a penalty that costs more than your company’s holiday party. If you are a small to medium-sized business owner, you are likely already juggling group health insurance for employers while trying to keep costs down. You might even be exploring affordable group health insurance options like Level funded health insurance or Reference… 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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The HHA Retention Crisis: Is Your Health Plan Actually Just a Resignation Letter?

Ed MacConnell

Maria sat in her office, the glow of her laptop screen the only light in the room. It was 7:30 PM on a Friday. Most of her friends were at dinner, but Maria was staring at an exit interview form, the fourth one this month. Her agency, "Graceful Care," was doing everything right. They had a waiting list of clients and a reputation for excellence. But Maria was losing the "Home Health Hustle." She was losing her best aides to the local hospital system, and she was losing her mind trying to replace them. "I offer health insurance," she told us when she first called Total Benefit Solutions Inc. "I… 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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Tired of “Doctor Not Covered”? How to Escape the HMO/EPO Trap in 2026

Ed MacConnell

You know the feeling. You’ve spent hours researching plans, comparing premiums, and finally hitting "enroll." Then, three months later, you try to schedule an appointment with your trusted specialist only to hear those four soul-crushing words: "We don't take that." This isn't just a minor inconvenience; it is the single most common complaint in the individual health insurance market today. If you feel like your options are shrinking while your premiums keep rising, you aren’t imagining it. The health insurance landscape has shifted dramatically, leaving many individuals and small business owners trapped in restrictive networks that dictate where they can go and who they can see. At Total Benefit Solutions… Read More

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Do You Really Need Minimum Value Plans? The Truth About the 2026 ACA Affordability Hike

Ed MacConnell

Navigating the world of employee benefits often feels like trying to read a map that changes every time you look at it. If you are a business owner or a HR manager, you’ve likely heard whispers about the upcoming "Affordability Hike" for 2026. This isn’t just another minor adjustment to the rules. The IRS recently released Revenue Procedure 2025-25, which sets the new standards for what constitutes "affordable" health insurance under the Affordable Care Act (ACA). At Total Benefit Solutions Inc, we believe that staying ahead of these changes is the only way to protect your business from hefty penalties. We act as your independent advocate, cutting through the bureaucracy… Read More

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Dr Ben E Fitz Total Benefit Solutions, Inc

Dr. Ben E. Fitz and the Mandated Leave Maze: Survival Guide for 2026

Ed MacConnell

Welcome to 2026, where the only thing rising faster than the morning sun is the complexity of state-mandated benefit laws. If you feel like you’re wandering through a hedge maze without a map, you aren’t alone. Small and medium-sized business (SMB) owners across the country are currently facing a "tug-of-war" that would make a professional athlete sweat. On one side, you want to provide top-tier benefits to keep your best talent; on the other, you’re trying to keep the lights on while insurance premiums continue to climb. I’m Dr. Ben E. Fitz, and today we’re going to talk about the newest wall in that maze: Mandated Paid Family Leave (PFML).… Read More

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Dr Ben E Fitz Total Benefit Solutions, Inc

Care for the Caregivers: Unique Benefits Home Health Teams Actually Want

Ed MacConnell

If you run a home healthcare agency, you already know the statistics: but that doesn’t make them any easier to swallow. Currently, the home-based care industry is facing a turnover crisis that would make most business owners' heads spin. Recent data shows that caregiver turnover has hit a staggering 77%, with nearly four out of five caregivers leaving within their first 100 days of employment. In the "war for caregivers," the traditional approach to group health insurance for employers isn't enough anymore. When your margins are being squeezed by Medicare and Medicaid rate changes, and your staff is constantly being recruited by the agency down the street, you need a… Read More

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