Quick answer: In 2026, NEMT insurance commonly runs roughly $5,000 to $12,000 per vehicle per year for commercial auto at a $1M combined single limit, with many operators landing near $7,000–$9,000 per van. Adding general liability, sexual abuse & molestation, and workers' comp brings a typical fully-insured cost to about $6,000–$15,000+ per vehicle annually. Pricing varies widely by state, vehicle type, limits, and loss history.
There is no single sticker price for NEMT insurance, and any quote that gives you one without asking questions should make you nervous. What we can do is show you realistic 2026 industry ranges per vehicle and explain exactly which levers move your number, so you can budget honestly and shop smart.
NEMT insurance is not one policy; it is a stack of four. Here is how the typical annual cost tends to break out per vehicle. Treat these as broad industry ranges, not quotes.
| Coverage | Typical annual range (per vehicle) |
|---|---|
| Commercial auto (livery, $1M CSL) | $5,000 – $12,000 |
| General liability | $500 – $1,500 |
| Sexual abuse & molestation (SAM) | $300 – $1,000 |
| Workers' compensation (per driver) | Varies by payroll & state class rate |
| Typical all-in per vehicle | $6,000 – $15,000+ |
Commercial auto is by far the largest line. It also swings the most, because it reflects the accident exposure of putting a passenger vehicle on the road for hire all day.
Two operators running identical vans can pay very different premiums. These are the factors carriers weigh most heavily:
Litigation climate, medical costs, and minimum-limit rules vary enormously. The same van insured in a high-severity state can cost multiples of what it costs in a lower-cost state.
A standard minivan is cheaper to insure than a wheelchair-accessible van with a lift, which is cheaper than a 10-plus passenger cutaway bus. More passengers and more equipment mean more exposure and higher premiums.
Moving from a $1M to a $1.5M combined single limit, which some brokers require, raises the commercial auto premium. It is money well spent when a contract demands it, but it is a real line-item difference.
Your prior claims (loss runs) and your drivers' motor vehicle records (MVRs) are the fastest way to move your price up or down. Clean MVRs and a claim-free history are the single best discount available.
Minimum driver age, years of experience, and documented safety/background-check procedures all influence pricing, and they directly affect your abuse & molestation and auto rates.
Per-vehicle cost often drops as your fleet grows, because insurers spread fixed costs and reward scale, provided your loss ratio stays healthy.
Physical damage coverage (comprehensive and collision) on your own vehicles is usually optional and priced separately, with deductibles commonly $1,000–$2,500. Liability, the part brokers and states require, does not carry a deductible in the same way. If you finance your vehicles, your lender will typically require physical damage coverage, adding to the totals above.
Use the ranges above to build a per-vehicle budget, then get an actual quote based on your vehicles, drivers, state, and required limits. Because NEMT is a specialized for-hire livery risk excluded by standard fleet auto, the accurate number only comes from a carrier that underwrites this class. Beware anyone quoting a flat price sight unseen; it usually means a coverage gap you will discover at claim time.
• Medicaid.gov — Non-Emergency Medical Transportation (NEMT) overview
• FMCSA — Insurance requirements for for-hire passenger carriers
NEMT Insurance Pros quotes commercial auto, general liability, abuse & molestation, and workers' comp per vehicle, built to your state and broker requirements.
Request a quote or call (818) 356-8150
Cost ranges are typical 2026 industry figures for illustration only, not quotes or guarantees. Actual premiums vary widely by state, vehicle type, limits, driver records, and loss history. NEMT Insurance Pros is the national non-emergency medical transportation insurance practice of Thrive Risk Management.