NEMT insurance cost
No insurer, Medicaid broker or state agency we checked publishes an average NEMT premium, so treat any single per-van figure you find online with caution. Three published numbers anchor the price: RLI, an E&S market for hard-to-place NEMT accounts, lists a $50,000 minimum premium without stating the policy term; New York ambulette providers who answered the state's 2022 Medicaid review put 9% of their operating costs toward insurance; and Progressive says paying in full takes 10% or more off. Your own quote turns on the liability limit your broker contract names, where and how far you drive, your drivers' records, your vans and their equipment, your claims and your years in business.
Updated . Written by Andre Beukers, principal at Redoubt, a commercial insurance agency in Salt Lake City, not a government office.
Is there an average cost for NEMT insurance?
Not one that rests on an insurer's rates. On October 3, 2026 we read the NEMT pages of RLI, National Interstate, Draco (part of Amwins Underwriting) and Progressive Commercial, New York's 2022 Medicaid ambulette rate report, a 2021 Louisiana House resolution and MACPAC's 2021 report to Congress. Progressive's 2025 average monthly premiums "ranged from $260 for contractor autos to $926 for for-hire transport trucks," with none for livery or NEMT. Draco prints its minimum premium as "Varies." Per-van ranges on agency and software blogs are not an insurer's published rate, so this page leaves them out.
What is published is a floor and a share. RLI's E&S auto unit, which calls itself a solution for hard-to-place NEMT and paratransit risks, lists a $50,000 minimum premium among its NEMT criteria without saying the policy term, and says its policies cannot be domiciled, or vehicles registered, in CT, KS, KY, MA, MT, NC, NV, NY or WV. New York's Department of Health surveyed its Medicaid ambulette providers on 2021 costs, and the averaged responses put 9% of operating costs on insurance. DOH calls its own study "inherently flawed" because of its 27% response rate, so read the 9% as one state's self-reported proportion, not a price.
| Source | What it publishes | What it tells you |
|---|---|---|
| RLI, E&S auto | $50,000 minimum premium; no term stated | A floor at a market for hard-to-place NEMT, closed to nine states |
| Draco (Amwins) paratransit program | Minimum premium "Varies"; $1M auto liability | No floor to plan on |
| Progressive Commercial, NEMT page | No figure; price factors and discounts, 10% or more off for paying in full | The price depends on the account's factors |
| Progressive Commercial, cost page | 2025 monthly averages from $260 to $926 for contractors, business autos, trucks and tow trucks | Not an NEMT number; no passenger class is listed |
| New York Department of Health, 2022 | Insurance at 9% of ambulette operating costs in 2021 | A self-reported share from a study DOH calls flawed, not a premium |
What decides the price of an NEMT policy?
The limit you have to carry comes first, and the contract sets it. MTM Health's Nevada provider page says "All transportation providers must have general and automobile liability policies of no less than $1,500,000 each." Progressive lists policy limits and deductibles among the features of a business that set a livery rate, so the limit on your own contract's insurance page, MTM's or another broker's, is one of the inputs to your premium.
Then the account itself. Progressive's NEMT page says the price depends on your location and travel radius, driving history, the vehicle's age and type, the vehicle's value including equipment, claims history and coverage needs, and that "Younger drivers or those with limited experience may affect your eligibility or premium rates." RLI says it can consider vehicles with wheelchair accessibility modifications, requires modifications and permanently attached equipment to be fully disclosed, and asks for a stated amount for each vehicle on the schedule.
Place matters. RLI lists "Higher-risk territories including South Florida, South Texas, Los Angeles County in California, San Francisco County in California or Cook County in Illinois" among the accounts it will consider. In Utah, Code 31A-22-305(5)(b) requires anyone who accepts payment for transporting people to carry uninsured motorist coverage of at least $25,000 per person and $500,000 per accident on every vehicle used for it.
Why is NEMT insurance so expensive?
The public record shows NEMT insurance costs rising without measuring why, and no source we checked compares NEMT premiums with other commercial auto classes. New York's Health Department added an ambulette rate add-on in June 2022 "to help cover provider costs related to increasing personnel and insurance costs," noted that providers and their associations cite rising insurance as "a significant financial hurdle," and proposed to investigate the causes with the state's Department of Financial Services.
Louisiana's House recited in a 2021 resolution that NEMT providers were "experiencing increasing business costs due to a steep escalation in the cost of the vehicle insurance that they are required by the state Medicaid program to carry," and resolved only to urge the Louisiana Department of Health to study Medicaid NEMT rates and ways to finance them. MACPAC's 2021 report to Congress heard interviewees attribute strained NEMT networks partly to "high vehicle insurance costs, low Medicaid payment rates."
On the underwriting side, the carriers say what they price. RLI, an E&S market that calls itself a solution for hard-to-place NEMT and paratransit risks, says its NEMT solutions are based on factors including "issuance of a non-renewal or cancellation notice, claim issues (frequency and/or severity), lack of industry experience/being a new venture and the need for dedicated loss control support." It adds: "Each risk is reviewed individually based on its operations, fleet, loss history and other underwriting characteristics." Progressive says it writes NEMT in select states.
How do I get an NEMT insurance quote?
Start from the contract, not the insurer. Get the insurance page of your broker or facility agreement first, because a quote at the wrong limit is a quote you cannot use: Draco's program lists $1M of auto liability, which on its own is below the $1,500,000 for each policy that MTM's Nevada provider page requires.
Then send a complete submission early enough for the markets that need one. RLI clears a submission 90 days or less from its effective date, with four years of loss runs valued within the past 90 days and a vehicle schedule giving each unit's seating capacity, modifications and stated amount, and it also wants current MVRs for all drivers. Draco asks for an industry standard application, its paratransit supplemental application, MVRs and at least three years of loss runs.
Compare quotes line for line: the same limits, the same vehicles at the same stated amounts, the same deductibles and the same coverages, and ask each for the paid-in-full price and the installment total. Progressive quotes online or through an agent; RLI tells operators to ask their wholesale broker for an RLI quote; Draco's program is distributed through a select group of retail brokers. Who you ask decides which of these prices you see.
How much is NEMT insurance per month?
No market we checked publishes a monthly NEMT figure, and none of the carrier pages we read offers an NEMT cost calculator. Progressive's monthly averages stop at contractors, business autos, trucks and tow trucks, and its livery page says "There isn't a one-size-fits-all livery insurance cost" before sending you to a quote for your exact price. RLI does not say what term its $50,000 minimum premium covers, so it does not convert to a monthly number.
How you pay changes the monthly number. Progressive says paying in full gets "10% or more off your premium" where the discount is offered, so the same Progressive policy costs more on a payment plan. Ask every market for both totals, and divide the one you will pay by the number of vans to set a cost per vehicle against your contract's trip rates. MTM's Nevada page says its rates are "discussed and determined with transportation providers on an individual basis," so that comparison is yours to make.
How can I make NEMT insurance more affordable?
Qualify for what the markets say they reward, and never buy below the contract. A policy under the $1,500,000 on MTM's Nevada provider page does not meet MTM's requirement there, and Progressive's own advice is "Make sure you're not risking quality coverage for a cheaper insurance rate."
- Time and experience: Progressive discounts for three or more years in business, for prior livery experience, and for already carrying a BOP or general liability policy.
- Pay in full where the discount exists; Progressive says 10% or more.
- Take a deductible you can fund: National Interstate says a deductible option can lower your upfront premium cost if you take on a limited amount of risk.
- Put telematics and cameras in the vans: National Interstate says integrating real-time driver data can help lower your insurance costs, RLI lists discounts on Samsara, Lytx, Motive, Netradyne and IntelliShift hardware and subscriptions among its partnership benefits, and Draco's program page lists tie-down procedures, passenger safety protocols, driver training and vehicle cameras as measures to help reduce claims and insurance expenses.
- Hire and keep clean drivers: Progressive says younger or less experienced drivers can affect your premium, and RLI wants current MVRs on every driver.
- Mid-term moves: RLI lists a mid-term submission looking for lower premium as an ineligible risk.
Does a new NEMT business pay more for insurance?
No market we checked publishes a new-venture surcharge. What the pages show is that a new business misses discounts an established one gets: Progressive's for three years in business and for prior livery experience. Draco's program lists three years in business and a minimum of five units among its eligible accounts. RLI lists lack of industry experience or being a new venture among the factors its NEMT solutions are based on, and says it can consider new ventures.
Are general liability and workers' compensation part of the NEMT price?
They are separate policies. MTM Health's Nevada provider page requires general liability of $1,500,000 alongside the auto policy, and workers' compensation that meets state requirements. Draco's program covers auto liability and physical damage and says general and professional liability are available through another carrier. Price all three when you weigh a contract.
Will one claim raise my NEMT premium?
It can. Progressive lists claims history among the factors in an NEMT price, and RLI lists claim issues, by frequency or severity, among the factors its NEMT solutions are based on. Both specialty markets read loss runs: RLI asks for four years of them, Draco at least three.
Where these answers come from
Each entry carries the exact words of the source so you can check it yourself. Forms, rules and carrier pages change; read the current version before acting.
- 1. RLI, E&S Auto, NEMT insurance page, NEMT & paratransit criteria
“$50,000 minimum premium Mixed fleets. Any modifications or permanently attached equipment must be disclosed on the submission”
rlicorp.com, accessed October 3, 2026. Two consecutive items of the "NEMT & paratransit criteria" list. The page's structured data describes the product as offered "with $50,000 minimum premium." Neither states the policy term. A carrier's statement about its own product. - 2. RLI, E&S Auto, NEMT insurance page, introduction
“For pre-approved E&S producers, RLI Transportation is a solution for hard-to-place NEMT & paratransit risks.”
rlicorp.com, accessed October 3, 2026 - 3. RLI, E&S Auto, NEMT insurance page, availability
“Policies cannot be domiciled in and vehicles cannot be registered in the following states: CT, KS, KY, MA, MT, NC, NV, NY or WV.”
rlicorp.com, accessed October 3, 2026 - 4. RLI, E&S Auto, NEMT insurance page, NEMT & paratransit criteria
“NEMT & Paratransit insurance solutions are based on several factors, including but not limited to issuance of a non-renewal or cancellation notice, claim issues (frequency and/or severity), lack of industry experience/being a new venture and the need for dedicated loss control support”
rlicorp.com, accessed October 3, 2026 - 5. RLI, E&S Auto, NEMT insurance page, FAQ: Does RLI offer NEMT and paratransit insurance?
“Each risk is reviewed individually based on its operations, fleet, loss history and other underwriting characteristics.”
rlicorp.com, accessed October 3, 2026 - 6. RLI, E&S Auto, NEMT insurance page, FAQ: Does RLI insure new NEMT businesses?
“RLI can consider new NEMT and paratransit ventures or businesses with limited industry experience.”
rlicorp.com, accessed October 3, 2026 - 7. RLI, E&S Auto, NEMT insurance page, FAQ: Does RLI insure NEMT vehicles with wheelchair accessibility modifications?
“RLI can consider modified vehicles as part of an eligible NEMT or paratransit fleet. Vehicle modifications and permanently attached equipment must be fully disclosed during the submission and underwriting process.”
rlicorp.com, accessed October 3, 2026 - 8. RLI, E&S Auto, NEMT insurance page, NEMT & paratransit criteria
“Higher-risk territories including South Florida, South Texas, Los Angeles County in California, San Francisco County in California or Cook County in Illinois”
rlicorp.com, accessed October 3, 2026 - 9. RLI, E&S Auto, NEMT insurance page, submission clearance requirements, vehicle schedule
“Vehicle schedule: Excel is preferred, including licensing state, garaging city and state, year, make, model and VIN, specific use, seating capacity, modifications or permanently attached equipment and stated amount”
rlicorp.com, accessed October 3, 2026 - 10. RLI, E&S Auto, NEMT insurance page, submission clearance requirements, loss runs
“Loss Runs: 4 years of currently valued hard copy loss runs valued within the past 90 days or less of the effective date (5th year may be required after file review)”
rlicorp.com, accessed October 3, 2026 - 11. RLI, E&S Auto, NEMT insurance page, submission clearance requirements, effective date
“Effective date: 90-days or less from the effective date”
rlicorp.com, accessed October 3, 2026 - 12. RLI, E&S Auto, NEMT insurance page, additional requirements
“Financials: may be requested, including the two most recent year-end audited financial statements, balance sheet and income statement on an accrual basis Current MVRs for all drivers”
rlicorp.com, accessed October 3, 2026. Two consecutive items of the "Additional requirements" list. - 13. RLI, E&S Auto, NEMT insurance page, ineligible risks
“Mid-term submission looking for lower premium Vehicles with 15+ passenger capacity including the driver”
rlicorp.com, accessed October 3, 2026. The first two items of the "Ineligible risks" list. - 14. RLI, E&S Auto, NEMT insurance page, benefits of an RLI Transportation partnership
“Discounts on hardware and subscription costs from Samsara, Lytx, Motive, Netradyne & IntelliShift”
rlicorp.com, accessed October 3, 2026. Each vendor name is a link on the page. - 15. RLI, E&S Auto, NEMT insurance page, not an agent or broker
“For insurance quotes for E&S non-emergency medical transportation and paratransit, ask your wholesale broker for a quote from RLI.”
rlicorp.com, accessed October 3, 2026 - 16. Progressive Commercial, Non-Emergency Medical Transportation insurance page, How much does NEMT insurance cost?
“How much you pay for NEMT insurance depends on a variety of factors, including your:”
progressivecommercial.com, accessed October 3, 2026. The list that follows: location and travel radius; driving history; vehicle's age and type; vehicle's value, including equipment; claims history; coverage needs. A carrier's statement about its own pricing. - 17. Progressive Commercial, NEMT insurance page, insurance requirements, driver age and qualifications
“Younger drivers or those with limited experience may affect your eligibility or premium rates.”
progressivecommercial.com, accessed October 3, 2026 - 18. Progressive Commercial, NEMT insurance page, How much does NEMT insurance cost?
“Make sure you're not risking quality coverage for a cheaper insurance rate. It's important to have a non-emergency medical transportation insurance policy that both fits your budget and offers adequate protection.”
progressivecommercial.com, accessed October 3, 2026 - 19. Progressive Commercial, NEMT insurance page, common ways to save
“We write non-emergency medical transportation insurance in select states and offer several discounts to help you save.”
progressivecommercial.com, accessed October 3, 2026. The page does not list the states. - 20. Progressive Commercial, NEMT insurance page, common ways to save on NEMT insurance
“Years in business: Save on your premium if you've been in business for three years or more. Prior livery experience: Qualify for a discount when you have previous experience transporting people. Existing business insurance: Earn additional savings if you already carry an active BOP or general liability policy. Paying your policy in full: Get 10% or more off your premium when you pay your policy up front.”
progressivecommercial.com, accessed October 3, 2026. Footnotes on the same page: discounts "vary and may not be available in all states and situations"; the paid-in-full discount is "Not available in all states and situations." - 21. Progressive Commercial, NEMT insurance page, what is NEMT insurance
“Get an online quote in minutes or reach out to an agent to find the right coverage.”
progressivecommercial.com, accessed October 3, 2026 - 22. Progressive Commercial, Livery insurance page, How much does livery insurance cost?
“There isn't a one-size-fits-all livery insurance cost. Instead, your rate will depend on specific features of your business, such as:”
progressivecommercial.com, accessed October 3, 2026. The list that follows: company size, service type, location, claims history, vehicle, coverages, driving record, policy limits and deductibles. The section ends "When you're ready to see your exact price, start a quote." - 23. Progressive Commercial, Commercial Auto Cost page
“In 2025, the national average monthly cost for commercial auto insurance through Progressive Commercial ranged from $260 for contractor autos to $926 for for-hire transport trucks.”
progressivecommercial.com, accessed October 3, 2026. Footnote: "2025 new policy premium per power unit for liability and physical damage coverage for policies with no driver violations." The page gives averages for business auto ($276), contractors ($260), for-hire specialty and transport trucks ($734 to $926) and tow trucks ($606); no livery, NEMT or other passenger class. - 24. Draco (Amwins Underwriting), Paratransit/NEMT program page, introduction
“Draco, part of the Amwins Underwriting division, offers an exclusive Paratransit insurance program that is distributed through a select group of retail brokers.”
amwins.com, accessed October 3, 2026. "Draco" and "Amwins Underwriting" are links on the page. - 25. Draco (Amwins Underwriting), Paratransit/NEMT program page, eligible accounts
“Eligible accounts Three years in business Minimum five units”
amwins.com, accessed October 3, 2026. A heading and the first two items of its list. - 26. Draco (Amwins Underwriting), Paratransit/NEMT program page, coverage
“Coverage Auto liability Physical damage GL/PL are also available via another carrier”
amwins.com, accessed October 3, 2026. A heading and its three list items. - 27. Draco (Amwins Underwriting), Paratransit/NEMT program page, program details
“Minimum premium Varies Limits Auto liability - $1M”
amwins.com, accessed October 3, 2026. Two label and value pairs of the program details panel. - 28. Draco (Amwins Underwriting), Paratransit/NEMT program page, submission requirements
“Submission requirements Industry standard application Paratransit supplemental application MVRs Loss runs (minimum of 3 years)”
amwins.com, accessed October 3, 2026. A heading and its four list items. - 29. Draco (Amwins Underwriting), Paratransit/NEMT program page, Mitigating Paratransit Risks
“Draco's Dan Podolski shares his perspective on the safety measures and policies NEMT operators should implement to help reduce claims and insurance expenses. Operators should be aware and consider the benefits of: Proper Tie-Down Procedures Passenger Safety Protocols Driver Training Vehicles Cameras”
amwins.com, accessed October 3, 2026. Draco's own recommendation, quoted as what Draco says. Two paragraphs and a four-item list; "Vehicles Cameras" as printed. - 30. National Interstate, Non-Emergency Medical Transport page, deductible options
“If you are looking to lower your upfront premium cost and take on a limited amount of risk, a deductible option may be right for you.”
natl.com, accessed October 3, 2026. A carrier's statement about its own product. - 31. National Interstate, Non-Emergency Medical Transport page, telematics
“Unlock the full potential of telematics by integrating real-time driver data with our insights and expertise to help lower your insurance costs.”
natl.com, accessed October 3, 2026 - 32. MTM Health, Nevada transportation providers FAQ, insurance coverage
“All transportation providers must have general and automobile liability policies of no less than $1,500,000 each. MTM Health must be listed as a Certificate Holder and Additional Insured on both polices. Additionally, your company must hold worker’s compensation insurance that meets state requirements.”
mtm-inc.net, accessed October 3, 2026. MTM Health's Nevada transportation providers FAQ. The page states MTM's terms for its Nevada network; this page does not apply the figure to other states or brokers. The quote keeps MTM's "polices" and curly apostrophe. - 33. MTM Health, Nevada transportation providers FAQ, trip rates
“All details regarding rates are discussed and determined with transportation providers on an individual basis.”
mtm-inc.net, accessed October 3, 2026. MTM Health's Nevada transportation providers FAQ. The page states MTM's terms for its Nevada network; this page does not apply the figure to other states or brokers. - 34. Utah Code 31A-22-305(5)(b)(i), uninsured motorist coverage for passenger carriers (effective May 6, 2026)
“All persons, including governmental entities, that are engaged in the business of, or that accept payment for, transporting natural persons by motor vehicle, and all school districts that provide transportation services for their students, shall provide coverage for all motor vehicles used for that purpose, by purchase of a policy of insurance or by self-insurance, uninsured motorist coverage of at least $25,000 per person and $500,000 per accident.”
le.utah.gov, accessed October 3, 2026. Versioned file effective 5/6/2026, read with curl -k. - 36. New York State Department of Health, Medicaid Ambulette Rate Review Report 2022, limitations
“Due to the low (27%) response rate, this study is inherently flawed and therefore, OHIP is unable to draw conclusions about rate adequacy.”
health.ny.gov, accessed October 3, 2026. New York State Department of Health, Medicaid Ambulette Rate Review Report 2022, written under Chapter 632 of the Laws of 2021 (PDF created February 2023). Costs are for calendar year 2021, self-reported by 66 providers. - 37. New York State Department of Health, Medicaid Ambulette Rate Review Report 2022, other initiatives
“In June 2022, an additional ambulette-specific add-on was created to help cover provider costs related to increasing personnel and insurance costs.”
health.ny.gov, accessed October 3, 2026. New York State Department of Health, Medicaid Ambulette Rate Review Report 2022, written under Chapter 632 of the Laws of 2021 (PDF created February 2023). Costs are for calendar year 2021, self-reported by 66 providers. - 38. New York State Department of Health, Medicaid Ambulette Rate Review Report 2022, other initiatives
“Additionally, to address the rising cost of insurance which is often cited by ambulette providers and associations as a significant financial hurdle, the DOH proposes to investigate causes of rising insurance costs with the NYS Department of Financial Services”
health.ny.gov, accessed October 3, 2026. New York State Department of Health, Medicaid Ambulette Rate Review Report 2022, written under Chapter 632 of the Laws of 2021 (PDF created February 2023). Costs are for calendar year 2021, self-reported by 66 providers. - 39. Louisiana House Resolution No. 196, 2021 Regular Session, enrolled, recital
“WHEREAS, NEMT providers are experiencing increasing business costs due to a steep escalation in the cost of the vehicle insurance that they are required by the state Medicaid program to carry; and”
legis.la.gov, accessed October 3, 2026. A WHEREAS recital, not the operative clause; the House resolved only to request a study (see la-hr196-resolved). It sets no rate. - 40. Louisiana House Resolution No. 196, 2021 Regular Session, enrolled, resolving clause
“THEREFORE, BE IT RESOLVED that the House of Representatives of the Legislature of Louisiana does hereby urge and request the Louisiana Department of Health to study Medicaid rates for nonemergency medical transportation services and potential means of financing of those services.”
legis.la.gov, accessed October 3, 2026. The further clauses ask for a report to two House committees by October 1, 2021. - 41. MACPAC, June 2021 Report to Congress on Medicaid and CHIP, Chapter 5: Mandated Report on Non-Emergency Medical Transportation
“Interviewees attributed strain on provider networks to a variety of factors, including high vehicle insurance costs, low Medicaid payment rates, and increased competition for drivers from companies like UPS and Amazon.”
macpac.gov, accessed October 3, 2026. What MACPAC's interviewees told it, reported by the commission.
A Medicaid transportation broker wants the certificate before credentialing
NEMT and wheelchair van operators: who writes the coverage, what it costs, and what brokers such as Modivcare ask for.
Elsewhere on the site
Pricing an NEMT contract?
Send Redoubt the insurance page of your broker or facility agreement, your vehicle list with any lifts or ramps, your drivers and your loss runs. We will talk through which markets fit the account, what each will ask for, and what moves the price.
This is general insurance information, not legal advice or a coverage determination. The policy forms, the endorsements the carrier issues, and the requirement in writing from whoever is asking control.