NEMT Insurance Cost in 2027: What Sets Your Premium and How to Lower It

Private insurers do not publish price lists for NEMT insurance. Each insurer sets your premium from its own rates and underwriting rules. Minnesota’s human services department noted in January 2019 that commercial auto rates and policy terms are driven mainly by competition among insurers and their underwriting practices, and are less regulated in Minnesota than personal auto. You cannot look up your price, but you can control most of what goes into it.

What NEMT insurance costs: the published numbers

These are the dated figures regulators and a broker have published. None of them is a quote for your company.

What it measures	The number	Who published it
Commercial auto rates, national average	Up 8.8 percent in the second quarter of 2025, the 56th straight quarter of increases	NAIC, citing a broker survey (2025 first half report)
Commercial auto losses	More than $10 billion in underwriting losses over the two years to mid-2025, mostly in liability. Liability losses equaled 71.4 percent of premiums in the first half of 2025.	NAIC (2025 first half report)
MTM Health’s own premium per vehicle, $1 million deductible	$1,456 (2019), $1,580 (2020), $1,797 (2021), $2,145 (2022)	MTM Health (January 9, 2024)
Workers’ comp, Washington class 1404, cabulance and paratransit	$2.0322 per hour worked in 2026, up 7 percent from $1.8916. L&I has proposed $2.1652 for 2027, not yet final as of September 2026.	Washington L&I
Workers’ comp, Washington class 4904, clerical office	$0.2223 per hour worked in 2026	Washington L&I

MTM Health’s figures show the trend, not a small company’s price. With a $1 million deductible, MTM pays the first $1 million of a loss itself, so its premium covers far less than a small company’s policy does. Its premium still rose 47 percent from 2019 to 2022. In the same post, MTM wrote that premiums were rising mainly to offset historically poor underwriting, that several carriers had left the NEMT insurance market, and that the ones still writing it had raised rates.

Workers’ comp: a worked example

Washington’s state fund, run by the Department of Labor and Industries (L&I), publishes its workers’ comp rates by job class. Class 1404 covers companies that give on-demand, prearranged, nonemergency rides to passengers with special needs, usually in accessible vans. It includes driving, helping riders in and out, and vehicle upkeep. It does not apply to wheelchair vans run with a taxi or ambulance service, and dispatchers with no other duties go in class 4904 instead (WAC 296-17A-1404).

L&I counts a full-time worker as 1,920 hours a year. At 2026 base rates:

Worker	Hours a year	2026 rate per hour	Base premium a year
Full-time van driver, class 1404	1,920	$2.0322	$3,901.82
Full-time dispatcher with no other duties, class 4904	1,920	$0.2223	$426.82

Each company’s actual rate is the base rate times its experience factor, which reflects its own claims. L&I’s 2026 table assumes an average factor of 0.91. Washington workers pay part of the premium, about 24 percent on average, according to L&I.

Washington is unusual. L&I notes that most states charge workers’ comp as a percentage of payroll, not per hour, and that Washington is the only state where workers pay a significant share. In most states private insurers set the premium, and the NAIC says a new business’s premium may be based on its payroll, number of employees, pay per employee, and type of work, with safety history counting once the business is established. See workers’ comp for NEMT drivers for when you must carry it, and experience modification rate for how claims move your price.

What drives your commercial auto premium

The Maryland Insurance Administration’s guide to commercial insurance (July 2024) lists the factors that move a business auto premium. Here is what each one means for a NEMT fleet.

Factor	What the insurer looks at	What you can do
Type of vehicle	Premiums are linked to the type of vehicle	Get a quote on the exact van before you buy it
Safety and anti-theft equipment	Safety devices, alarms, and tracking systems that locate a stolen vehicle may lower the premium	Tell your agent what each van has
Where vans are parked	An indoor garage or locked lot may qualify for a lower premium	Park overnight in a secured lot and say so on the application
Where you operate	Heavy traffic, theft, and severe weather can mean higher rates	Give accurate garaging addresses for every van
Driving and claims history	Records and past claims affect both price and whether an insurer will cover you	Screen drivers before you hire them
Coverage limits	The higher the limit, the higher the premium	Buy the limits your contracts require
Deductible	The higher the deductible, the lower the premium	Choose one you can pay from cash
Insurance history	A lapse in coverage can raise the premium or lead an insurer to refuse you	Renew before the old policy ends

Maryland’s guide adds a warning that matters for every NEMT owner: the risk your drivers present can exceed an insurer’s underwriting guidelines and keep you from getting coverage with the company you want.

Your contracts set your limits, and limits set your price

Your contracts decide the lowest limits you can carry. As of September 2026:

Program	Auto liability	General liability
MTM Health, standard agreement (January 1, 2023 copy)	$500,000 combined single limit	$500,000 each occurrence, $500,000 aggregate
MTM Health, Missouri	At least $2 million	At least $2 million
Riders carried for pay across a state line, vehicle seating 15 or fewer	$1.5 million (49 CFR 387.33T)	Not set by this rule
Riders carried for pay across a state line, vehicle seating 16 or more	$5 million (49 CFR 387.33T)	Not set by this rule

Because a higher limit means a higher premium, a new contract can raise the cost of every van you insure. Before you sign with a broker or a health plan, get its insurance section in writing and ask your agent to price it. The NEMT insurance requirements guide lists the limits and endorsements states and brokers ask for.

Seats matter too. Under the federal rule, a vehicle seating 16 or more, driver included, needs more than three times the coverage of one seating 15 or fewer on interstate trips. Choose your van size with that in mind if you cross state lines.

When licensed insurers say no: surplus lines and state plans

If licensed insurers will not take your account, an agent may place part of it with a surplus lines insurer: a company not licensed in your state but allowed to cover risks licensed insurers will not take. Compare that quote carefully, because the protections differ. Texas shows how it works, as of September 2026:

• The agent must first try to place you with a Texas-licensed insurer (Texas Department of Insurance, updated April 25, 2025).
• Surplus lines insurers in Texas do not sell auto liability. If no licensed insurer will sell you auto liability, the Texas Department of Insurance says your only option is the Texas Automobile Insurance Plan Association (TAIPA). Its state-approved commercial auto rates rise 4.9 percent on average for new and renewing policies starting November 1, 2026.
• Surplus lines insurers are not members of a guaranty association, so claims could go unpaid if the insurer fails.
• Surplus lines insurers do not have to let the state review their policies or rates, according to the Texas Office of Public Insurance Counsel.
• The premium carries a state tax of 4.85 percent, which the surplus lines agent reports and pays (Texas Comptroller).

Ask your agent whether each quote is from a licensed insurer, a surplus lines insurer, or a state plan, and whether taxes and fees are included. For the steps that get a new or turned-down account placed, see NEMT insurance denied.

How to lower your NEMT insurance cost

1. Price contracts before you sign them

List every program you work with and the limits each requires. Buy to the highest one, and price any new contract’s insurance rules first.

2. Hire drivers insurers will accept

Pull a motor vehicle record before you hire, and ask your agent for the insurer’s driver guidelines in writing. MTM Health’s standard agreement already requires a driving record covering the previous three years, renewed yearly. The driver background check guide covers the rest of the screening.

3. Get your loss runs every year

Request your loss runs from each insurer, in writing, a few months before renewal, and check them for errors. Florida gives insurers 15 calendar days to send one after a written request, requires it to cover your last five years with that insurer, and bars a fee for one statement a year.

4. Keep claims small and well documented

Report every incident the day it happens with an incident report form, and follow a set plan after a crash. See what to do after a NEMT vehicle accident.

5. Put each worker in the right workers’ comp class

Ask your insurer or state fund which class fits each job, and do not let office staff land in the driver class by default. In Washington, dispatchers with no other duties go in the clerical class, at $0.2223 an hour instead of $2.0322 in 2026. Give honest payroll and sales estimates too: Maryland’s guide says liability premiums built on those estimates can be audited at the end of the term, with a bill or a refund for the difference.

6. Use your state’s discount programs

• Georgia. Employers certified as a drug-free workplace by the State Board of Workers’ Compensation get a 7.5 percent reduction on workers’ comp premiums. Certification costs $35, and you send the certificate to your insurer each year. MTM Health’s standard agreement already asks for drivers’ drug and alcohol screening results before hire, after an accident, on suspicion, and at random, though certification has its own rules.
• Pennsylvania. A certified workplace safety committee earns a 5 percent workers’ comp discount each year. It needs at least two employer and two employee representatives and six full months of operation. You first apply 90 to 30 days before your policy renews, then renew the certification each year.

Ask your state’s workers’ compensation agency whether it has similar programs.

7. Pick a deductible you can cover

A higher deductible lowers the premium. Keep enough cash to pay it more than once in a year.

8. Show the insurer your safety practices

The NAIC says businesses with solid, documented safety practices may be charged lower premiums, and that safety devices can help. Keep written policies for driver training, vehicle inspections, and wheelchair securement, and hand them to your agent at renewal. If you add cameras, NEMT dash cameras covers what they record and the privacy limits.

9. Never let coverage lapse

A gap can raise your next premium or lead insurers to refuse you. It can also end a broker contract: MTM Health’s standard agreement ends immediately if you fail to keep insurance. Renew early and send certificates before the old ones expire.

10. Shop at renewal, and compare like with like

The NAIC advises comparing equivalent coverage from several insurers and asking how much premiums have risen over the past five years. Compare the same limits, deductibles, endorsements, and vehicle list on every quote. When a van leaves service, tell your insurer, and tell MTM Health at once if it is on a scheduled auto policy.

Budget for insurance before you buy the van

Insurance must be in force before your first ride, so its cost starts before your revenue does. Get quotes on the exact vehicles you plan to buy, at the limits your first broker requires, before you sign the purchase papers.

Then turn the premium into a cost per trip:

Insurance cost per trip = total yearly premiums ÷ paid trips per year

Add that number to fuel, driver pay, and the van payment when you decide whether a broker’s rates work for you. The cost per mile calculator and the startup cost guide show where insurance fits in the rest of your budget.