Healthcare reform brings many changes to the health insurance market, and to help support these new programs, you will see a difference in the amounts you pay on your monthly invoice.

The Affordable Care Act includes several federally mandated fees to help pay for various parts of reform, like funding public exchanges, conducting research and supporting the individual market. The following federally mandated fees will affect your monthly invoice amounts beginning January 2014:

  • Market Share fee (also known as the annual fee on health insurance providers)
  • Patient-Centered Outcomes Research Institute (PCORI) Fee
  • Transitional Reinsurance Program Fee
  • Risk Adjustment User Fee
  • Federally-Facilitated Exchange User Fee

These fees impact grandfathered and non-grandfathered health plans differently.

Market Share Fee

The market share fee helps to provide tax subsidies for low-income individuals and families who buy insurance through a public exchange. This permanent fee, which begins in 2014, is based on how much premium each health insurance collects. This fee impacts both grandfathered and non-grandfathered health plans.

Patient-Centered Outcomes Research Institute (PCORI) Fee

The PCORI fee helps to fund the Patient-Centered Outcomes Research Institute, which supports clinical effectiveness research. This fee impacts both grandfathered and non-grandfathered health plans.

The PCORI fee began in 2012 and will phase out in 2019. For the first plan year (ending after September 30, 2012), you will be charged $1 per member per year. For the next plan year, you will be charged $2 per member per year. The fee will increase for inflation in the following years.

Transitional Reinsurance Program Fee

The transitional reinsurance program fee will help fund a three-year program designed to help insurance carriers that cover individuals with high claim costs. The fee is $63 per member per year in 2014 and is designed to decrease in 2015 and 2016. This fee impacts both grandfathered and non-grandfathered health plans.

Risk Adjustment User Fee

The risk adjustment fee is a one-time fee that funds the government’s Risk Adjustment Program, which also helps insurance carriers that cover individuals with high claim costs. You will be charged $1 per member per year in 2014. This fee only impacts non-grandfathered platinum, silver, gold and bronze health plans.

Federally-facilitated Exchange User Fee

The federally-facilitated exchange user fee helps to fund and support federal exchanges. Health insurance carriers will be charged 3.5 percent of their premium for all business on a federal exchange in 2014. This fee only impacts non-grandfathered health plans.

To learn more about healthcare reform topics, visit our Healthcare Reform section.