PCORI Fee Due July 31 

Employers who sponsored self-funded medical plans that ended sometime during 2024 are required to report and pay the ACA Patient-Centered Outcomes Research Institute (PCORI) fees no later than July 31, 2025. Fully insured plan sponsors can rely on their carriers to submit the fee on their behalf, but fully insured plan sponsors that sponsor a self-funded plan component such as a health reimbursement arrangement (HRA) or a flexible spending account (FSA) will need to file and pay for the self-funded component plan. 

This chart summarizes the type of insurance coverage, whether it’s covered by the fee, and who is responsible for paying and reporting the fee. 

Payment amounts due in 2025 will differ based on the employer’s plan year. The fees due in July 2025 are as follows: 

• $3.22 per covered life for plan years ending after September 30, 2023, and before October 1, 2024 
• $3.47 per covered life for plan years ending after September 30, 2024, and before October 1, 2025 

Self-funded plans may use one of three methods to determine the average covered lives used for reporting and paying the PCORI fee: (i) the actual count method; (ii) the snapshot method; or (iii) the Form 5500 method. There are special counting rules that apply to employers offering multiple self-funded plans or a health reimbursement arrangement (HRA) integrated with a fully insured plan. 

The PCORI fee count and payment are submitted using IRS Form 720. 

Reminder: Form 5500 Due July 31 for Calendar Year Plans 

Employee health and welfare plan administrators with at least 100 participants must file an IRS Form 5500 each year by the last day of the seventh month after the end of the plan year. This means plan sponsors with calendar year plans must file annually by July 31. 

Plan sponsors may file an extension, which delays the annual filing deadline for calendar year plans to October 15. Get more information about filing Form 5500. 

Bone Mass Measurement Testing Covered Under Medicare Part B 

Medicare Part B (Medical Insurance) covers bone mass measurement testing once every 24 months (or more often if medically necessary) for participants who meet one or more of these conditions: 

• You’re a woman whose doctor determines you’re estrogen-deficient and at risk for osteoporosis, based on your medical history and other findings. 
• Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures. 
• You are taking prednisone or steroid-type drugs or are planning to begin this treatment. 
• You’ve been diagnosed with primary hyperparathyroidism. 
• You’re being monitored to see if your osteoporosis drug therapy is working. 

Your doctor or other healthcare provider may recommend you get services more often than Medicare covers, or they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for some or all of them. 

Holiday Closures

Our offices will be closed on Thursday, June 19, and Friday, July 4, in observance of the Juneteenth and Independence Day holidays.