The PCORI fee was established under the Affordable Care Act (ACA) to fund the Patient-Centered Outcomes Research Institute, which supports research comparing the effectiveness of different medical treatments and strategies. This research helps patients, providers, and policymakers make better-informed healthcare decisions.
Although the original ACA provision was set to expire, Congress reinstated the PCORI fee through plan years ending before October 1, 2029. As a result, employers and insurers must continue to budget for and file this fee annually.
Who Pays the Fee
- Self-Insured Plans: Employers who sponsor self-insured medical plans are responsible for calculating and paying the PCORI fee directly.
- Fully Insured Plans: The insurance carrier pays the fee on behalf of the plan sponsor.
The fee applies to major medical plans, including Health Reimbursement Arrangements (HRAs) that are not integrated with a fully insured medical plan. It generally does not apply to Health Savings Accounts (HSAs), standalone dental or vision plans, or most excepted benefits.
Filing and Payment
- Due Date: The PCORI fee is due July 31, 2026, for plan years ending in 2025.
- Filing Method: Employers must report and pay the fee using IRS Form 720 (Quarterly Federal Excise Tax Return).
- Calculation: The amount owed is determined by multiplying the average number of covered lives under the plan by the applicable dollar amount for the plan year.
For example, a self-insured plan with an average of 500 covered lives for the 2025 plan year would owe $1,920 (500 × $3.84).
Why It Matters
While the PCORI fee is modest compared to other ACA-related costs, HR and benefits teams should ensure timely filing and payment to remain compliant. Failing to submit the fee can result in IRS penalties.
Beyond compliance, it’s worth noting that these funds play a meaningful role in improving U.S. healthcare. PCORI’s research helps identify which treatments work best for specific populations and conditions, supporting better outcomes for patients and more informed benefit design for employers.
In Summary
- New PCORI fee: $3.84 per covered lifefor plan years ending on or after October 1, 2025, and before October 1, 2026.
- Applies to: Self-insured plans and fully insured plans (carriers pay for the latter).
- Due date: July 31, 2026.
- Filing form: IRS Form 720.
HR professionals should confirm which plans are subject to the fee, update internal compliance calendars, and coordinate with finance or payroll to ensure proper filing. Staying on top of the annual PCORI update supports both compliance and broader efforts to advance evidence-based healthcare.
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This article is for informational purposes only and is not intended as legal, tax, or benefits advice. Readers should not rely on this information for taking (or not taking) any action relating to employment, compliance, or benefits. Always consult with a qualified professional before making decisions based on this content.
