2019 ACA Taxes and Fees

The updated tax and fee schedules are now available.

For 2019, the following taxes and fees are required to be paid by insurers and self-funded groups under the Affordable Care Act1:

  • Patient-Centered Outcomes Research Institute (PCORI): the fee for 2019 is $2.45 per member per year. The fee ends October 1, 2019.
  • Health Insurer Fee (fully insured groups only): The percentage of premium is determined by product and renewal month, to reflect the moratorium in effect for 2019. 
Quarter HMO PPO
Q1 0.09% 0.28%
Q2 0.37% 1.12%
Q3 0.65% 1.96%
Q4 0.93% 2.81%

For fully insured groups, the group rate includes all applicable taxes and fees.

For self-funded groups, the PCORI fee must be paid directly to the Internal Revenue Service, using Form 720. Customers with questions about filing this form should consult with their tax advisor or accountant.

Download a chart outlining the specific provisions and correlating taxes and fees.

Please contact your Optima Health representative if you have any questions.

1 This information is intended to be a high-level summary of some of the changes to the ACA tax provisions. Optima Health is providing this to consumers and employers for informational purposes only. The information is not intended to provide compliance, tax, or legal advice, or to be relied upon for these purposes. Consumers and employers are advised to consult with legal and tax experts to understand how the law will affect their individual or business circumstances.