#healthcare
Financial management and accounting solutions for healthcare businesses
A 2026 walk-through of HSA, FSA, and HRA rules with the new contribution limits, the limited-purpose FSA stack that adds up to $7,800 of pre-tax room, and how small employers can use ICHRA and QSEHRA to compete with corporate benefits.
Section 4960 imposes a 21% excise tax when a tax-exempt organization pays a covered employee more than $1 million. The 2025 OBBBA expansion redefines "covered employee" as anyone employed since 2017, widening the tax base for hospitals, universities, and foundations filing Form 4720 in 2026.
Section 7702B defines tax-qualified long-term care insurance — age-indexed premium deductions up to $6,200 per person in 2026, tax-free benefits under the per diem cap, Section 1035 exchanges from old life or annuity contracts, and hybrid life-LTC structures for aging owners and retirees.
Section 7702B sets the federal rules that decide whether a long-term care policy delivers deductible premiums, tax-free benefits, and tax-free 1035 exchanges. This guide breaks down the 2026 age-indexed deduction limits, the $430 per-diem cap, hybrid life-LTC mechanics, and the planning patterns that move trapped cash value into care coverage without recognizing gain.
A practical breakdown of how travel nurses keep housing and meal stipends tax-free — covering the IRS tax home rule, the 12-month assignment cliff, duplicate-expense documentation, multi-state nonresident returns, and which states have reciprocity agreements.
Section 199A's 20% QBI deduction phases out entirely for high-income doctors, lawyers, consultants, and other specified service trades or businesses (SSTBs) — costing a married surgeon at $700,000 of K-1 income roughly $52,000 a year. This guide covers the 2026 income thresholds (~$394,600 MFJ phase-in, ~$544,600 fully phased out), the de minimis safe harbor at 10% / 5% of receipts, the anti-"crack and pack" rules under Reg. §1.199A-5(c)(2), and practical strategies like defined-benefit plans and W-2 wage planning to preserve the deduction.
Section 199A's SSTB rule denies the 20 percent qualified business income deduction to high-earning doctors, lawyers, consultants, and financial advisors. In 2026 the joint-filer phase-out runs from $403,500 to $553,500, and OBBBA added a permanent $400 minimum deduction for active business owners.
COBRA's notice scheme runs on five deadlines — 90, 30, 14, 60, and 45 days. Miss any one and a group health plan can face a $100-per-day Section 4980B excise tax, up to $110-per-day ERISA penalties, and private lawsuits. A practical guide for plan sponsors and HR teams.
For plan years ending in 2025, self-insured plan sponsors and HRA employers must file Form 720 by July 31, 2026 and pay $3.84 per covered life ($3.47 for plan years ending before October 1, 2025). This guide covers who owes the fee, the three approved methods to calculate average covered lives, why HRAs count employees only, and the common Form 720 filing mistakes that trigger IRS notices.
For 2026, QSEHRA caps tax-free reimbursements at $6,450 self-only and $13,100 family for employers under 50 FTEs, while ICHRA has no IRS cap and lets any-size employer vary contributions across 11 federal employee classes—provided the 9.96% affordability test, MEC requirement, and 90-day notice are all met.
A funding-model guide for small employers comparing fully-insured, level-funded, and self-funded group health plans, with the math on stop-loss coverage, ERISA fiduciary exposure, Form 5500 filings, and when each model actually saves money.
How the 2026 Health Savings Account combines tax-free contributions, tax-free growth, and tax-free medical withdrawals — and how the shoebox strategy turns an $8,750 family limit into a six- to seven-figure retirement vehicle by age 65.
