How much does medical malpractice insurance cost?

What the public record shows, and what it cannot

Medical malpractice has neither of the price sources other coverages have. No federal survey asks practices what they pay. None of the insurer and broker cost pages this site collects for other coverages gives a figure for physicians. The industry’s annual rate survey, the Medical Liability Monitor (MLM), is not published as open data. This page quotes its numbers only as they appear in the American Medical Association’s public analysis.

That analysis, by AMA lead economist Allen Hardiman (April 2026), uses MLM’s annual rate survey for 2016 to 2025⁠¹. Three limits shape how you should read it:

1. List prices, not invoices

   The rates are manual premiums. They “do not reflect credits, debits, dividends or other factors”. The AMA says they “should not be interpreted as the actual premiums paid by individual physicians”⁠¹.

2. Three specialties only

   general surgery, obstetrics/gynecology and internal medicine. Insurers usually report rates for $1 million per claim and $3 million per year, the most common limit⁠¹.

3. Partial market

   MLM covers companies writing 60% to 80% of the market, and no insurer in it writes nationwide⁠¹.

On the official side, the NAIC publishes market totals from insurers’ annual statements. In 2025 that came to $13.7 billion of direct premium for medical professional liability, about 1.2% of all property/casualty premium (our calculation from NAIC totals)⁠². Those totals describe the market, not any one practice’s price.

One insurer’s 2025 rates, by specialty and area

The AMA paper’s Exhibit 4 tracks one insurer per area over ten years, for $1M/$3M policies⁠¹. The AMA warns that each row represents a single insurer and “should not be generalized to reflect the experience of each state as a whole”⁠¹.

Scroll the table sideways to see every column.

Source: AMA Policy Research Perspectives, April 2026, Exhibit 4⁠¹.

What the table shows:

• Specialty multiplies the price. In Miami-Dade, the obstetrics rate is 4.1 times the internal medicine rate (our calculation: $243,988 ÷ $59,736). The AMA links this to claim risk: general surgeons and obstetricians are the physicians most likely to be sued⁠¹.
• Location multiplies it again. Internal medicine in Miami-Dade costs 7.2 times the Los Angeles rate (our calculation). The AMA attributes California’s low rates to its cap on noneconomic damages under MICRA. The cap was $250,000 until 2022 and rose to $350,000 in January 2023, and it steps up to $750,000 over ten years. The insurer’s California rates did not change at all from 2016 to 2025, and California’s average premiums were unchanged between 2024 and 2025⁠¹.
• Some areas are moving fast. The Philadelphia rates, which include the state fund surcharge, rose 31% to 34% between 2023 and 2025 in all three specialties. Obstetrics went from $101,398 to $135,974, or +34.1% (our calculation)⁠¹.

If you run a clinic or group, these per-physician rates are the starting point. In states with a patient compensation fund, the surcharge is added per provider (see below).

The trigger: occurrence, claims-made and the tail

Policies come in two forms, and the statutes treat them differently. Wisconsin’s mandate shows the distinction. An occurrence policy must carry at least $1,000,000 “for each occurrence” and $3,000,000 for all occurrences in a policy year. A claims-made policy must carry the same amounts per claim and per “reporting year”⁠⁸.

• Occurrence coverage pays for an incident that happened while the policy was in force, whenever the claim is filed. Nothing extra is owed when you leave.
• Claims-made coverage pays only for claims reported while a policy is in force, for care given after the retroactive date. When you retire, sell the practice or change insurers without keeping the retroactive date, care you already gave is uninsured unless you buy an extended reporting endorsement (the “tail”) or your new insurer covers prior acts.

Kansas makes claims-made the default. Its basic-coverage statute speaks of the “required claims made policy” and allows occurrence forms in lieu of it for residents in training and nonresident locum tenens physicians⁠¹¹. The Kansas fund also pays judgments against qualifying inactive providers. That is a statutory substitute for part of what a tail does elsewhere⁠¹².

Two states write the tail into the license rule:

• New Jersey requires the policy to include “extended reporting endorsement coverage for claims made policies, also known as ‘tail coverage’”, unless renewal coverage keeps the retroactive date⁠¹⁶.
• Massachusetts requires coverage to “be continued until the expiration of any statute of limitations relevant to the events or occurrences covered”, through occurrence coverage or “claims made with appropriate tail coverage”⁠¹⁵.

We found no public source for a standard physician tail price. When you compare a claims-made quote with an occurrence quote, ask for the tail price in writing, because on a claims-made policy that cost falls due when you leave, not while you practice.

Patient compensation funds: a second charge on top of the premium

In six states, physicians pay a surcharge into a state patient compensation fund (PCF) in addition to their insurance premium: Indiana, Kansas, Louisiana, Nebraska, New Mexico and Pennsylvania⁠¹. The private policy pays up to a set primary limit and the fund pays above it, usually up to a statutory cap. Wisconsin runs a similar fund that pays the part of a claim above the mandatory primary limits⁠⁹.

Scroll the table sideways to see every column.

Three ways these funds change the cost of coverage:

1. The surcharge moves separately from the premium

   Pennsylvania sets the Mcare assessment each year as a percentage of the prevailing primary premium charged by the state’s joint underwriting association. It can adjust a provider’s assessment by up to 20% for claims frequency and severity⁠⁷. Of the PCF-state increases in 2025, 73.0% came from the base premium (alone or with the surcharge). The rest came from the surcharge alone⁠¹.

2. PCF states saw more increases

   In 2025, 76.1% of reported premiums rose in PCF states, compared with 35.9% in non-PCF states⁠¹. Pennsylvania ranked first for large increases: 92.2% of its reported premiums rose, more than half by 10% or more, and the largest rise was 29.6%⁠¹.

3. The fund can lower the primary limit you need

   In Indiana and Louisiana, qualifying for the fund means filing proof of the primary coverage and paying the surcharge. The provider’s own insurer is then exposed only up to $500,000 (Indiana) or $100,000 (Louisiana) per claim⁠⁴⁠⁶. Fund participation is what gives you the cap.

Indiana’s fund shows the money involved. In 2024 it collected $150.2 million in surcharges and reported $170.5 million of judgments paid. Surcharge was filed for 43,512 providers through 133 carriers⁠⁵. That averages $3,465 per provider (our calculation, $150,766,028 ÷ 43,512). The provider count mixes physicians with hospitals and other facilities, so this is not a typical physician’s surcharge.

Where state law makes coverage a licensing condition

In these states, carrying coverage is a condition of practicing:

The consequences differ. Pennsylvania’s Mcare reports noncompliant providers to their licensing board and gives them no fund coverage⁠⁷. Wisconsin’s insurance commissioner notifies the licensing board of any provider that has not complied⁠⁸. Colorado’s doubling rule means two claim reports in one year can raise your required limit to $2M/$6M, and with it the premium⁠¹⁴. Indiana and Louisiana tie the primary coverage to the fund: a provider who does not qualify gets neither the fund’s excess layer nor the damages cap⁠⁴⁠⁶.

We checked the statutes of the states listed here only; other states may also require coverage.

Is the market hardening?

The AMA describes seven straight years of rising premiums, 2019 through 2025, “a pattern not observed since the early 2000s”⁠¹. The measure is the share of reported premiums that rose from the previous year:

Scroll the table sideways to see every column.

Source: AMA Policy Research Perspectives, April 2026, Exhibit 1⁠¹.

That is still well short of the last crisis: 77.4% of premiums rose in 2003 and 82.1% in 2004⁠¹. The AMA concludes that a nationwide hard market has not emerged, but some states already show hard-market conditions. It names Illinois, rising since 2020, and Pennsylvania, since 2023⁠¹. In 2025, 36 states had at least one increase, 18 had increases in at least half of their reported premiums, and 11 had at least one increase of 10% or more⁠¹. Besides Pennsylvania, the 10%-plus states included Rhode Island, Kansas, Utah, South Carolina, Kentucky, Florida, Georgia, Illinois, West Virginia and New York⁠¹.

Brokers see the same direction at a slower pace. CIAB member brokers reported medical malpractice renewals up 1.8% on average in Q2 2026, while all commercial accounts fell 2.0%⁠³. See market trends for the full series.

The NAIC’s 2025 figures show where the money goes. Medical professional liability insurers incurred losses equal to 58.8% of earned premium. Adding defense and cost-containment expense brings that to 77.1%, a gap of 18.2 points. For other liability, the line that includes general and most non-medical professional liability, the gap is 8.9 points (69.8% to 78.7%) (our calculation from NAIC ratios)⁠². In malpractice, defending claims costs about twice as much, relative to premium, as in other liability lines.

Direct premiums written/earned in thousands of US dollars; loss ratios = direct losses incurred / direct premiums earned (calendar year). National Association of Insurance Commissioners (NAIC), 2025 Market Share Reports for Property/Casualty Groups and Companies by State and Countrywide.

What moves an individual practice’s premium

Taken together, the sources above point to these levers:

1. Specialty

   In the AMA sample, obstetrics costs four to seven times internal medicine in the same area, and in Miami-Dade general surgery costs the same as obstetrics⁠¹.

2. County and state law

   Rates follow local claim experience, which “can be influenced by state tort reforms such as caps on non-economic damages”⁠¹. California and Wisconsin cap noneconomic damages; Indiana and Louisiana cap total recovery for fund participants⁠¹⁠⁴⁠⁶⁠¹⁰.

3. Limits

   Mandates set the floor, from $100,000/$300,000 in Massachusetts to $1M/$3M in Colorado, New Jersey and Wisconsin⁠⁸⁠¹⁴⁠¹⁵⁠¹⁶. Connecticut’s rate in the AMA table is for $1M/$4M limits, so it is not directly comparable with the other rows⁠¹.

4. Claims history

   Pennsylvania adjusts the Mcare assessment by up to 20% for a provider’s claims experience, and Colorado doubles the required limit after repeated claim reports⁠⁷⁠¹⁴. Private insurers apply credits and debits of their own that the manual rates in the table do not show⁠¹.

5. Trigger and exit cost

   A claims-made policy defers part of its cost to the tail. Compare total cost over the years you expect to practice, not the first-year premium.

For nurses, therapists and home health agencies, see also professional liability. A slip-and-fall in your waiting room is a general liability claim. If you plan to rely on an umbrella for higher limits, check whether it excludes professional services.

Sources

1. 1
   American Medical Association (AMA), Policy Research Perspectives: For the seventh consecutive year, medical liability premiums continue to rise (April 2026) Checked 13 Oct 2026 · Back to text ↑
2. 2
   National Association of Insurance Commissioners (NAIC), 2025 Market Share Reports for Property/Casualty Groups and Companies Checked 13 Oct 2026 · Back to text ↑
3. 3
   The Council of Insurance Agents & Brokers (CIAB), Commercial Property/Casualty Market Index, Q2 2026 Checked 13 Oct 2026 · Back to text ↑
4. 4
   Indiana State Medical Association, Medical malpractice updates went into effect July 1 (ISMA Reports, July 11, 2019) Checked 13 Oct 2026 · Back to text ↑
5. 5
   Indiana Department of Insurance, Indiana Patient's Compensation Fund 2024 Annual Report Checked 13 Oct 2026 · Back to text ↑
6. 6
   Louisiana State Legislature, La. R.S. 40:1231.2, Limitation of recovery Checked 13 Oct 2026 · Back to text ↑
7. 7
   Pennsylvania Insurance Department, Mcare, About Mcare (December 2025) Checked 13 Oct 2026 · Back to text ↑
8. 8
   Wisconsin State Legislature, Wis. Stat. 655.23, Limitations of liability; proof of financial responsibility Checked 13 Oct 2026 · Back to text ↑
9. 9
   Wisconsin State Legislature, Wis. Stat. 655.27, Injured patients and families compensation fund Checked 13 Oct 2026 · Back to text ↑
10. 10
    Wisconsin State Legislature, Wis. Stat. 893.55, Medical malpractice; limitation of actions; limitation of damages Checked 13 Oct 2026 · Back to text ↑
11. 11
    Kansas Office of Revisor of Statutes, K.S.A. 40-3402, Professional liability insurance required as condition of active licensure Checked 13 Oct 2026 · Back to text ↑
12. 12
    Kansas Office of Revisor of Statutes, K.S.A. 40-3403, Health care stabilization fund Checked 13 Oct 2026 · Back to text ↑
13. 13
    Connecticut General Assembly, Conn. Gen. Stat. 20-11b, Professional liability insurance required Checked 13 Oct 2026 · Back to text ↑
14. 14
    Colorado General Assembly, Office of Legislative Legal Services, C.R.S. 13-64-301, Financial responsibility (Colorado Revised Statutes 2024, Title 13) Checked 13 Oct 2026 · Back to text ↑
15. 15
    Massachusetts Board of Registration in Medicine, 243 CMR 2.00, Licensing and the practice of medicine Checked 13 Oct 2026 · Back to text ↑
16. 16
    Supreme Court of New Jersey, Jarrell v. Kaul, M.D., A-42-13 (N.J. Sept. 29, 2015), quoting N.J.S.A. 45:9-19.17 Checked 13 Oct 2026 · Back to text ↑
17. 17
    Indiana Department of Insurance, Patient's Compensation Fund FAQs, version 3.0 (Feb. 2, 2026) Checked 13 Oct 2026 · Back to text ↑

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