Health Care Reform Website

Patient-Centered Outcomes Research Institute (PCORI) Fee

The Affordable Care Act created a private, nonprofit corporation known as the Patient-Centered Outcomes Research Institute (PCORI). The goal of PCORI is to serve as a resource so that patients, clinicians, purchasers and policy-makers can make informed health decisions.To achieve this goal, PCORI will create and manage a variety of effectiveness studies regarding the delivery of health care and the money to pay for these studies will be raised by a PCORI fee.

The PCORI fee will be imposed for each plan year ending on or after October 1, 2012 and before October 1, 2019.PCORI fees are based on a dollar amount times the average number of lives covered:

  • $1 for plan years ending on or after October 1, 2012 and before October 1, 2013
  • $2 for plan years ending on or after October 1, 2013 and before October 1, 2014
  • $2.08 for plan years ending on or after October 1, 2014 and before October 1, 2015
  • $2.17 for plan years ending on or after October 1, 2015 and before October 1, 2016
  • $2.26 for plan years ending on or after October 1, 2016 and before October 1, 2017
  • $2.39 for plan years ending on or after October 1, 2017 and before October 1, 2018
  • $2.45 for plan years ending on or after October 1, 2018 and before October 1, 2019

For the following plan years, the fee will increase in accordance with the percentage increase of the National Health Expenditures as determined by the Department of Health and Human Services

Plan sponsors of self-insured plans are responsible for paying the PCORI fee. For fully-insured plans, the issuer must calculate and pay the fee.Some plan combinations will result in the double counting of covered lives and additional fees.For example, if a group health plan consists of a fully-insured medical benefit and a self-insured prescription drug benefit, both the insurer and the plan sponsor would pay the fees for the same group of covered lives.

The fee must be reported using IRS Form 720 and paid no later than July 31st of the calendar year immediately following the last day of the plan year to which the fee applies.