Key Takeaways
- PCORI fees are adjusted each year to accommodate healthcare costs and spending, as well as inflation.
- Fees help fund critical research on health outcomes and medical treatments so doctors and patients can make informed decisions.
- Employers offering level-funded or self-insured health coverage must pay the fee by July 31.
There are times throughout the year when the Internal Revenue Service needs to adjust its fees to ensure the nation’s fiscal responsibilities are met. One such fee, the Patient-Centered Outcomes Research Institute (PCORI) fee, is paid by insurance providers and businesses that offer employee health insurance. It is adjusted each year to reflect changes in healthcare costs and spending, as well as inflation.
PCORI is an independent, nonprofit organization that studies healthcare outcomes and the efficacy of medical treatments so patients and medical professionals can make informed healthcare decisions. The nominal fee helps fund this critical research.
For 2026, the fee has been updated to $3.84 per covered life for plans established on or after Oct. 1, 2025, and before Oct. 1, 2026.
So, how do you know if the PCORI fee applies to your business? How is it calculated, and when’s the deadline for payment? The LewerBenefits team has outlined that information below to help you and your business remain compliant.
Who pays the fee?
Employers who offer level-funded or self-insured health insurance plans (plans funded by the employer) are required to pay PCORI fees.
If your company offers employees a fully insured plan (employer-sponsored plans purchased through a health insurance company), the health insurance company would be responsible for the fee.
How is the fee calculated?
The total amount of the PCORI fee depends on the average number of individuals covered by the health insurance plan you offer, multiplied by the applicable dollar amount for that year ($3.84 for 2026). This includes the insured employee, their spouses, and any dependents enrolled in the plan.
For example, for 2026, the PCORI fee for a family of four (the insured, their spouse, and their two children) would be 4 x $3.84, or $15.36. You will need to complete this calculation for all insured individuals within your organization.
When is the fee due?
PCORI fees are due each year by July 31 of the year following the last day of the plan year and are reported and paid annually as part of filing IRS Form 720, otherwise known as the Quarterly Federal Excise Tax Return. So, for plans issued in 2025, your PCORI fees are due by July 31, 2026. Missing this deadline could result in penalties and fees assessed by the IRS.
How can LewerBenefits help?
There are many nuances to being a business owner, including the benefits you offer and the taxes and fees associated with them. If you’re unsure of whether you’re required to pay a PCORI fee or if you need additional resources on the fee and how to pay, LewerBenefits can help.
