How Much Does Medical Malpractice Insurance Cost in 2026? Rates by Specialty and State

A mature claims-made $1M/$3M medical malpractice policy usually costs about $5,000 to $250,000 or more per physician per year. Specialty and county explain most of the range. 2025 Medical Liability Monitor manuals cited in the AMA's 2026 report show $8,274 for a Los Angeles internist and $243,988 for Miami-Dade obstetrics or general surgery.

That band is a budget tool for an independent group, not a binder. Step year, entity structure, NP and PA scheduling, credits, and whether more than one A-rated carrier actually priced the roster all move the check you write.

What a Published Rate Is and Is Not

Filed Manual Versus the Check You Write

Medical Liability Monitor prints insurer manual rates at $1M/$3M for mature claims-made internists, general surgeons, and obstetrician-gynecologists. The AMA Policy Research Perspectives report uses that MLM series to track how reported premiums moved from year to year. The manual is the filed starting cell. Claims-free credits, risk-management courses, part-time factors, deductibles, and surplus-lines loadings can land the invoice well above or below it.

A hallway number from a colleague is not a comparable rate until you know whether the policy is mature or still stepping, claims-made or occurrence, whether the entity shares a limit, and whether the price is a county cell or statewide blend.

The $1M/$3M Convention Used Throughout

Independent physicians still buy $1 million per claim / $3 million aggregate as the default tower. Some high-severity counties and hospital-adjacent contracts push $2M/$4M or more. Unless a sentence says otherwise, every dollar figure below is $1M/$3M.

Why This Year's Premium Is Often the Wrong Planning Number

Most physicians buy claims-made coverage. The first year is a slice of the mature annual. Carriers then step the rate, commonly over four or five years, until it reaches the mature cell. Plan on the mature cell. If a partner may retire, a sale is on the table, or a site may close, add a tail estimate.

The 2025-2026 Market, in Two Datasets

The AMA's 2026 analysis, using MLM data, records a seventh consecutive year of rising medical professional liability premiums from 2019 through 2025. In 2025, 39.9% of reported premiums increased, 57.0% were unchanged, and 3.1% decreased. Thirty-six states recorded at least one reported increase. Eighteen states saw half or more of reported premiums rise. Eleven states had at least one premium up 10% or more.

MLM's 2025 Rate Survey shows a milder average overall rate change of +1.9%, with 62% of reported physician rates held flat. The two publications answer different questions. AMA/MLM describes how many reported premiums moved and how hard they moved in the worst venues. The MLM survey average describes the mean change across the reported book.

MLM's 2025 survey also reported a median NP premium of $2,576. That is a mid-level planning marker, not a physician class rate.

Rates by Specialty at $1M/$3M

Specialty class	Los Angeles 2025	Connecticut 2025	Miami-Dade 2025
Internal medicine	$8,274	$22,467	$59,736
General surgery	$41,775	Higher than IM	$243,988
OB/GYN	$49,804	$159,537	$243,988

Class comes first. Surgery, obstetrics, and procedure mix set the rate sheet before your personal claims file does, unless you already have a claims file.

This MLM survey does not publish a cell for every board. Office-based cognitive specialties without procedures often price near internist. Family medicine that includes obstetrics, endoscopy, or interventional pain is not the internist cell. Emergency medicine, anesthesiology, and hospital medicine sit above internist and can approach surgical territory. Orthopedics, neurosurgery, and bariatric surgery typically price at or above general surgery. Deliveries put you in the OB cell even if gynecology fills most of the calendar.

Rates by State and Venue at $1M/$3M

State is the second lever. County is frequently the one that actually moves the indication. New York is many markets. Miami-Dade is not Florida. Philadelphia is not the rest of Pennsylvania.

State / venue	2025 movement	Illustrative manual
Pennsylvania	92.2% of reported premiums up; PA average +6.7%	Three consecutive years of increases
New York	95.7% of reported premiums rose; NY average +4.2%	Metro high-severity counties dominate
Florida (Miami-Dade)	10%+ increases in 2024 and 2025	IM $59,736; GS and OB/GYN $243,988
Illinois	10%+ in 2024 and 2025	Chicago-class cells sit far above downstate
Kentucky	10%+ in 2024 and 2025	Pressure is statewide, not only urban
Connecticut	AMA specialty examples	IM $22,467 to OB/GYN $159,537
California (Los Angeles)	Cheaper large-market manuals	IM $8,274; GS $41,775; OB/GYN $49,804

Underwriters rate jury climate, plaintiff's-bar activity, and how readily a case survives summary judgment. A state-average malpractice premium is almost useless for an independent practice budget. Ask for the county-and-class cell.

Why the Cycle Is Still Up Into 2026

2019 through 2025 is the seventh straight year of rising MPL premiums in the AMA/MLM series. Even with an MLM average change of only +1.9% as of July 1, 2025, 39.9% of reported premiums went up and 3.1% went down. Independent groups usually hear severity, not a sudden spike in claim counts. Larger verdicts, more expensive defense, and reinsurance all feed the indication.

Line Items That Sit on Top of the Physician Cell

The Entity

Five physicians are not five solo policies stapled to one tax ID. The PC, PLLC, or partnership will be named. It needs a limit so a suit against the entity does not consume one doctor's $1M. Shared versus separate entity limits change both premium and how a claim hits the tower.

NPs, PAs, and Other Allied Clinicians

Mid-levels are exposure. They are not free riders on the physician rate. MLM's 2025 median NP premium of $2,576 is a market marker, not your endorsement. Supervisory language, independent practice authority, and separate versus shared limits all change the price.

Hours, Locums, and Moonlighting

FTE factors are real. A 0.5 FTE internist should not buy a 1.0 cell. Locums who work your clinic need to be scheduled or excluded in writing.

Exit Cost: Tail and Prior Acts

On claims-made paper, last year's premium is not the cost of leaving. Tail is typically 150% to 250% of mature annual premium; market conversations often quote 150% to 300%.

Building a 2026 Number an Independent Group Can Defend

Map each physician to specialty class and county. Pick a conservative mature $1M/$3M figure. Put entity coverage, NP and PA heads, and any higher limits on the same page. Subtract only credits the application can prove. Reserve tail when ownership can change. Then market the file rather than treating a seventh hard year as a reason to accept one indication.

Worked Planning Sketch (Not a Quote)

A five-physician independent roster in a moderate venue—three internists, one general surgeon, one OB/GYN, two NPs, mature $1M/$3M claims-made, separate entity limit—can reasonably plan $130,000 to $340,000 all-in before tail. Move that roster onto Miami-Dade manuals and the surgical and OB lines alone can exceed $480,000.

Questions That Separate a Complete Quote From a Cheap One

What step year is this? Is defense inside or outside limits? Who is scheduled? How many A-rated markets saw the file? A year-two claims-made price that looks inexpensive will not look inexpensive at maturity. Independent groups should see competing paper.

What These Figures Cannot Do

This article is educational. It is not a premium indication, a promise that coverage is available, or legal or insurance advice. Actual cost depends on applications, records requests, loss runs, and underwriter judgment.

FAQ

How much does medical malpractice insurance cost?

Mature claims-made $1M/$3M coverage typically runs about $5,000 to $250,000 or more per physician per year. Specialty and venue drive most of the spread.

What is the average malpractice premium for physicians in 2026?

There is no useful national average for an independent-group budget. Your county-and-specialty cell matters more than any blended average.

How much does malpractice insurance cost by specialty?

Anchor on internist, general surgery, and OB/GYN. Los Angeles 2025: internal medicine $8,274, general surgery $41,775, OB/GYN $49,804. Miami-Dade: internal medicine $59,736; general surgery and OB/GYN $243,988.

Which states have the most expensive malpractice insurance?

High-severity reported books in 2025 included New York and Pennsylvania. Florida's Miami-Dade manuals are among the highest in the AMA write-up. Illinois and Kentucky also saw 10%+ increases in both 2024 and 2025.

Do nurse practitioners pay the same as physicians?

No. MLM's 2025 Rate Survey reported a median NP premium of $2,576. Actual NP cost depends on specialty mix, supervision, state practice authority, and limit structure.

Is occurrence cheaper than claims-made?

Occurrence usually costs more each year because tail is already inside the rate. Claims-made looks cheaper until you buy tail or stay long enough for step rates to mature.

Independent physician groups that want a current read on $1M/$3M pricing can have Sheltra compare 5+ A-rated insurers in a 7-minute coverage review. Book a free coverage review at https://www.getsheltra.com/