The Affordable Care Act established the Patient-Centered Outcomes Research Institute (PCORI) to explore the effectiveness, risks and benefits of medical treatments, and the ACA mandates that fees be collected annually to fund this research.
The updated PCORI fee for 2025 is $3.47 per member, up from $3.22 last year. This fee applies to plan and policy years that end between October 1, 2024, and September 30, 2025. The fee is due July 31, 2025.
PCORI fees are paid annually with the submission of IRS Form 720. Anthem pays the fee for our clients with Fully Insured funding. Self-insured clients pay the PCORI fee directly to the IRS. Small Group Anthem Balanced Funding (ABF) clients may need your guidance on calculating and paying the fees.
The IRS allows the fees to be calculated by any one of the following methods:
- The actual count method. Total lives covered each day of the year, divided by the number of days in the plan year.
- The snapshot method. Total lives covered on one date in each quarter of the plan year.
- The snapshot factor method. Lives covered on any one day may be determined by counting the actual number of lives covered on that day or by treating those with self-only coverage as one life and those with coverage other than self-only as 2.35 lives.
- The Form 5500 method. A formula that includes the number of participants reported on Form 5500 for the plan year.
Please share this information with your clients who may need your assistance