PCORI Fees

Oh, PCORI fees- from the dawn of the ACA, these pesky little things have been confusing groups and bothering us. We thought we would be done with them by now, but a budget reconciliation bill in 2019 extended them another 10 years, so here we are.
PCORI fees are used to help fund the Patient-Centered Outcomes Research Institute (hence the name), which supports research to help consumers make informed healthcare decisions, and improve healthcare delivery.

The good news about these fees is that, despite the fact that everyone likes to talk about them, they really don’t impact our world too much. PCORI fees for fully insured plans are paid by the carrier and baked into the rates, so for most groups, they’re just a buzzword and nothing more. For your self-insured groups and HRAs, however, you do need to make sure the fees are being paid.

Groups with a TPA and some carriers may be paying the fees - or at least collecting them - on behalf of the group, so make sure that you check with them before you start the calculation process. For those groups that do need to pay, the process isn’t all that scary. The easiest way to calculate your participants is to count the number of lives covered on each day of the year, then divide by number of days in the year. The IRS offers three other methods that you can read about in the link below, but they are a little more complicated, so we won’t dive into those right now.

The fee for 2020 plan years is $2.66 per person, and they are payable on the quarterly 720 tax forms. The fees are due 8/2/21 since 7/31 falls on a weekend this year. At least they will be over early, and we can go back to enjoying Shore Season in NJ!