$245 a month
Commercial auto, all small businesses
Insureon figure for all small businesses, not NEMT data, updated March 2026
Trucking and transportation
NEMT insurance
For non-emergency medical transportation providers running sedans, wheelchair vans and stretcher vans for Medicaid and private-pay riders: coverage, rules and cost drivers.
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What similar businesses pay
- Commercial auto, all small businesses
- $245 a month
- General liability, all small businesses
- $45 a month
- Workers’ comp, all small businesses
- $54 a month
Published benchmarks, not quotes. Your price depends on underwriting.
Cost
What nEMT insurance costs
$45 a month
General liability, all small businesses
Insureon figure for all small businesses, not NEMT data, updated March 2026
$54 a month
Workers’ comp, all small businesses
Insureon figure for all small businesses, not NEMT data, updated April 2026
Neither Insureon nor Progressive publishes NEMT-specific prices on its NEMT pages, so the figures above are general small-business benchmarks, not NEMT estimates. Insureon puts the full commercial auto range at under $375 to over $16,000 a year, and for NEMT the limit you must carry, set by state rules and broker contracts, is a major driver. In Virginia, moving from a minivan seating 6 to a van seating 7 or more raises the required limit from $350,000 to $1,500,000. Your real price depends on vehicle count and type, trip mix, driver records and the limits your broker contracts demand.
What moves your price
- Seating capacity, since larger vans carry higher required limits in states such as Virginia
- The liability limits and endorsements your Medicaid broker or managed care plan requires
- Service area and trip distance, including any out-of-state trips
- Driver history, vehicle age and type and the value of lifts, ramps and securement equipment
- Claims history and years in operation
- Restricted equipment: Progressive says carriers typically restrict vehicles with lightbars, sirens or life support equipment
Risks
The risks insurers price for
A rider injured in an unsecured wheelchair
A sudden stop that would bruise a seated passenger can seriously injure a rider whose chair was not tied down. In a 2018 PLoS One study of 475 video-recorded paratransit trips, the occupant restraint was not used or was misused on 88% of wheelchair trips, and tiedowns were misused on 19% of trips.
A fall on a lift or ramp
Many NEMT claims happen outside traffic. A rider slips on a lift platform, a ramp gives way or a rider falls during a door-to-door assist from the curb to a dialysis center entrance.
A driver hurt lifting a rider
Drivers and attendants strain backs and shoulders helping riders in and out of vehicles and operating lifts. Those injuries are workers’ comp claims, not auto claims.
An abuse allegation against a driver
Drivers are alone with vulnerable adults and sometimes children, which makes abuse allegations a distinct exposure. Insureon notes that general liability and malpractice policies typically exclude abuse and molestation claims.
A missed or wrong drop-off
A rider is left at the wrong address or misses a dialysis appointment. Insureon lists errors and omissions coverage for claims tied to missed appointments.
A lapse that costs the revenue
Medicaid brokers and managed care plans audit insurance. Louisiana’s Medicaid provider manual says the state may recoup all payments for trips made while a provider lacked the minimum insurance.
Coverage
Coverage to consider
Commercial auto liability
Progressive treats NEMT as livery, specialized commercial auto for vehicles that carry paying customers. It pays for injuries to riders and others when your vehicle is at fault; brokers may require more than the state minimum.
How commercial auto works →Hired and non-owned auto
Covers vans you rent or lease and employees’ cars used for trips. Louisiana’s Medicaid manual asks for auto policies written with symbols 7, 8 and 9 or 2, 8 and 9, which include these.
How commercial auto works →Physical damage
Collision and comprehensive on the van and its installed lift, ramp and securement equipment. Progressive lists equipment value as a rating factor.
How commercial auto works →Medical payments
Pays medical bills for riders and drivers after a covered accident regardless of fault. Progressive lists it among its NEMT coverages.
How commercial auto works →Sexual abuse and molestation
Bought as an endorsement or separate policy because general liability and malpractice forms typically exclude these claims.
General liability
Covers non-driving claims such as a rider tripping at your office or on a curb during an assist, depending on policy wording.
How general liability works →Workers’ compensation
Covers drivers and attendants hurt lifting riders or operating lifts. Whether it is required depends on your state and how many employees you have.
How workers’ compensation works →Errors and omissions
Insureon lists professional liability for NEMT providers to answer claims tied to missed appointments and other service failures.
How professional liability works →Rules
Requirements and filings
Federal Medicaid rules set the floor for drivers, while insurance limits come from state law and broker contracts. Virginia is shown as an example of state NEMT licensing; check your own state’s Medicaid agency and broker.
| Requirement | Applies to | What it means |
|---|---|---|
| 42 CFR 440.170 | State Medicaid NEMT brokers and their providers | Brokers must have oversight procedures making sure transport personnel are licensed, qualified, competent and courteous |
| Social Security Act 1902(a)(87), CMS SMD 23-006 | Every Medicaid NEMT provider and driver | No exclusion from federal health programs, a valid driver’s license for each driver and a process to disclose each driver’s driving history to the state |
| Virginia DMV NEMT carrier, 1 to 6 passengers | Vehicles carrying 1 to 6 passengers including the driver | $350,000 minimum liability |
| Virginia DMV NEMT carrier, 7 to 15 passengers | Vehicles carrying 7 to 15 passengers including the driver | $1,500,000 minimum liability, rising to $5,000,000 for 16 or more |
| Virginia DMV surety bond | Virginia NEMT carriers | $25,000 surety bond or letter of credit kept on file for 3 years |
| Virginia DMAS driver standards (May 2026) | Virginia Medicaid NEMT drivers | No more than two chargeable accidents or moving violations in three years, plus background checks including the Sex Offender Registry |
| 49 CFR 387.33T | For-hire interstate passenger carriers | $1,500,000 for vehicles seating 15 or fewer including the driver; $5,000,000 for 16 or more |
| CDL threshold, 49 CFR 383.5 | Vehicles designed for 16 or more passengers including the driver | A CDL is needed only at 16 or more passengers; states may still require a chauffeur’s license for vans |
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Pay less
How to lower the cost
- Ask about Progressive’s discounts for at least 3 years in operation, prior livery experience and other business policies, plus 10% or more off for paying in full.
- Train every driver on four-point tiedowns and shoulder belts, and keep the training records brokers require.
- Screen drivers against your broker’s standard before hiring; in Virginia that means no more than two chargeable accidents or moving violations in three years.
- Log lift and ramp inspections and repairs so you can show the equipment is maintained.
- Match vehicle size to your contracts, since a van seating 7 or more carries a higher required limit in Virginia.
- Keep certificates current and name the broker or state agency as required; Louisiana asks that the certificate say the coverage is for an NEMT vehicle.
Before you start
What underwriters ask for
- Vehicle schedule with VINs, seating capacity and wheelchair or stretcher positions
- Value of installed lifts, ramps and securement equipment
- Driver list with license numbers, dates of birth, experience and motor vehicle records
- Broker and managed care contracts with their required limits, endorsements and additional insureds
- Trip mix: ambulatory, wheelchair and stretcher share, average trip length and any out-of-state trips
- Driver training, background check and drug testing procedures
- Loss runs from prior insurers, including any abuse allegations
Common questions
NEMT insurance: questions
Can I do NEMT trips on a personal auto policy?
Generally not. Progressive treats NEMT as livery, a specialized commercial auto class for vehicles carrying paying customers, and states such as Virginia require NEMT carriers to hold specific limits and plates.
Do Medicaid NEMT drivers need background checks?
Federal law requires states to make sure each driver holds a valid license and is not excluded from federal health programs, and providers must disclose each driver’s driving history to the state. Many states go further; Virginia requires criminal background checks that include the Sex Offender Registry.
Does general liability cover an abuse allegation against a driver?
Usually not. Insureon notes that general liability and malpractice policies typically exclude abuse and molestation claims, so NEMT providers buy that cover as an endorsement or a separate policy.
How much insurance do I need to take a rider across state lines?
For-hire interstate passenger carriers need at least $1,500,000 for vehicles seating 15 or fewer including the driver under 49 CFR 387.33T. Virginia’s Medicaid agency also requires FMCSA operating authority for out-of-state trips.
Do NEMT drivers need a CDL?
Usually not. Under 49 CFR 383.5, a CDL is needed for vehicles designed to carry 16 or more passengers including the driver, which most NEMT sedans and vans are not. CMS notes that states may still require a chauffeur’s license or an equivalent for vans.
Can my Medicaid broker require more than the state minimum?
Yes. Virginia’s Medicaid agency notes that brokers may require more insurance than DMV does, so read the broker contract’s limits, endorsements and additional insured wording before you buy.
What happens if my NEMT insurance lapses?
The consequences depend on your broker contract and state rules, and they can reach past the policy. Louisiana’s Medicaid manual says the state may recoup all payments for trips made during a period without the minimum insurance.
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Sources (16)
- Insureon: commercial auto insurance cost (updated March 2026)
- Insureon: general liability insurance cost (updated March 2026)
- Insureon: workers’ compensation insurance cost (updated April 2026)
- Insureon: NEMT and paratransit insurance
- Insureon: home healthcare provider insurance (abuse and molestation exclusion)
- Progressive Commercial: non-emergency medical transportation insurance
- Progressive Commercial: livery insurance
- Frost, Bertocci and Smalley: wheelchair tiedown and occupant restraint practices in paratransit vehicles, PLoS One (2018)
- Louisiana Department of Health: Medicaid manual section 10.3, NEMT provider requirements
- eCFR: 42 CFR 440.170
- CMS: SMD 23-006, Medicaid Transportation Coverage Guide (September 28, 2023)
- Virginia DMV: non-emergency medical transportation carrier
- Virginia DMAS: NEMT FFS and provider enrollment (July 2025)
- Virginia DMAS: NEMT driver, attendant and vehicle requirements (updated May 26, 2026)
- eCFR: 49 CFR 387.33T, financial responsibility for motor carriers of passengers
- eCFR: 49 CFR 383.5, definitions
Figures are published third-party estimates, not quotes. Coverage depends on policy terms and underwriting, and rules vary by state. Updated October 2026.