The Affordable Care Act (ACA) established the Patient-Centered Outcomes Research Institute (PCORI) fee to help fund research that compares the effectiveness, risks, and outcomes of medical treatments and services. The fee generally applies to covered lives under applicable medical plans, including employees, retirees, spouses, and dependents.
2026 PCORI fee filing deadline
The PCORI fee is due directly to the IRS by July 31, 2026, for applicable health plans.
Who is responsible for filing and payment?
Fully insured medical groups: Anthem is responsible for filing IRS Form 720 and paying the PCORI fee. No action is required for fully insured medical coverage.
Self-funded medical groups, including ASO and Anthem Balanced Funding (ABF) groups: The employer or plan sponsor is responsible for filing IRS Form 720 and paying the PCORI fee directly to the IRS by July 31, 2026.
Employers that offer a Health Reimbursement Arrangement (HRA) or a Flexible Spending Account (FSA) may need to determine whether a separate PCORI fee applies to those arrangements unless they qualify as excepted benefits.
2026 PCORI fee rates
The applicable rate depends on the plan year end date:
- $3.47 per covered life for plan years ending on or after October 1, 2024, and before October 1, 2025
- $3.84 per covered life for plan years ending on or after October 1, 2025, and before October 1, 2026
Employers should use the rate that corresponds with their applicable plan year end date when calculating the fee.
Counting covered lives
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.
ASO and ABF groups can use membership reporting available through Anthem's Client Information Insights, or CII, portal to help support their calculation.
For additional information, you can refer clients to the IRS PCORI Fee website.