PCORI Fee is Due July 31, 2026
The Patient-Centered Outcomes Research Institute (PCORI) fee deadline is around the corner. In Notice 2025-61, the IRS adjusted the applicable dollar amount to be multiplied by the average number of covered lives for purposes of calculating the fee for policy years and plan years that end on or after October 1, 2025, and before October 1, 2026. The fee for the forgoing period is $3.84. For policy years and plan years that ended on or after October 1, 2024, and before October 1, 2025, the fee is $3.47. Although the PCORI fee is based on the plan year, the reporting and fee due date is always July 31. The Affordable Care Act (ACA) requires health insurers and sponsors of self-funded group health plans and HRAs to pay the fee using IRS Form 720. For plan sponsors with both a self-funded group health plan and an HRA with the same plan year, only one fee is owed. However, if the plan sponsor’s self-funded group health plan and HRA have different plan years, then the fee must be paid for both plans.
The PCORI fee is based on covered lives. Accordingly, both employees and retirees and their covered spouses and children generally must be counted, and the count is determined based on the entire plan year.
The PCORI fee is small and was initially in effect from 2012 through 2019. However, in December 2019, the Further Consolidated Appropriations Act, 2020 extended the fee to plan/policy years ending before October 1, 2029. It is designed to fund research into the most effective ways of treating various diseases. The IRS has not announced the fee for subsequent plan years beyond 2026.
Innovative Benefit Planning is currently working with clients’ carriers to determine covered lives and assist with the calculation. Reach out to us if you have questions or need assistance calculating your PCORI fee.
