Where malpractice insurance costs the most (and least) in 2026

The same physician, doing the same work, pays almost ten times as much for malpractice coverage in the most expensive state as in the cheapest. Not ten percent more. Ten times.

Ranked by the median filed rate across 19 specialties, Michigan tops the list at about $35,206 a year. Wisconsin sits at the bottom at about $3,675. That is a 9.6-times gap on the identical basis, and it is the single clearest fact in malpractice pricing: where you practice can matter more than what you practice.

• Most expensive — $35,206 · Michigan, median across specialties
• Least expensive — $3,675 · Wisconsin, by a wide margin
• Top-to-bottom gap — 9.6x · On the identical filed basis
• Single-carrier states — 16 · Flagged rather than smoothed over

Every figure below comes from carrier rate filings on record with state insurance departments (the SERFF system and state DOIs), normalized to one basis so states compare cleanly: $1M/$3M limits, mature claims-made, manual rate. Each state's number is the median across all 19 specialty groups we track, so no single high-cost or low-cost specialty skews it. This is filed data, not a survey or an estimate.

The most expensive states for malpractice coverage

Five states cluster at the top, all with median filed rates above $28,000 a year:

• Rank — State · Median

Michigan, Illinois, and New Jersey lead the country. A physician in one of these states pays a median well above $30,000 a year before any personal credits or debits, and the top specialties run far higher: an OB/GYN or general surgeon in a high-cost state can clear six figures on the manual rate alone.

A note on depth, because this is a ranking other people will cite. States marked with an asterisk currently rest on a single filed carrier in our data, so their exact position is directionally sound but thinner than a multi-carrier state's. New Jersey, West Virginia, New Mexico, and Connecticut all sit high on the list on a single carrier's filings. We flag them rather than smooth them over.

The least expensive states

At the other end, coverage is a fraction of the price:

• Rank — State · Median

Wisconsin is the cheapest state in the country by a wide margin, with a median filed rate of about $3,675. The Upper Midwest and Plains dominate the low end. California is the eye-catcher on this list: the nation's largest medical market prices near the bottom, at about $7,828, a reminder that market size and price do not move together.

The full 2026 ranking

Here is where all 51 jurisdictions land, median filed rate across 19 specialties, highest to lowest. Dots mark states currently standing on a single filed carrier.

What separates the top from the bottom

The difference is not medical. A hip replacement in Michigan is the same operation as a hip replacement in Wisconsin. What changes is the legal and structural environment around the claim, and it works through a few levers.

Damage caps come first. States that limit noneconomic damages tend to give carriers a more predictable ceiling on losses, and predictability shows up as lower premiums. Wisconsin, the cheapest state, caps noneconomic damages and also runs a state patient compensation fund that backstops large claims. Illinois, near the top, has no cap: its courts struck down earlier attempts as unconstitutional, and its premiums sit accordingly high.

The ranking above is a map of legal environments as much as medical ones.

The relationship is not one-to-one, and that is worth saying plainly. Michigan caps noneconomic damages and still tops the table, which tells you caps alone do not set the price. Severity of verdicts, how aggressively cases are litigated, and how many carriers actually compete for business in a state all push the number too. A state with one or two carriers writing physicians has less price competition than one with a dozen. Patient compensation funds, which pool the risk of large claims in states like Wisconsin, Pennsylvania, and Indiana, are another structural piece.

We take the drivers apart in a dedicated piece on caps, tort reform, and patient compensation funds.

What it means if you practice in a high-cost state

A high-cost state does not mean every quote in that state is fair, and it does not mean you are stuck with the first number you are shown. It means the baseline is higher, so the range of what carriers will offer is wider, and the value of shopping the market is greater.

Two physicians in the same high-cost state, same specialty, can be quoted very differently depending on which carriers are competing for their risk that year, their claims history, and their territory within the state. The filed median tells you where the middle of the market sits. Your own number can land above or below it for legitimate reasons. The national picture and the specialty spread put the two levers side by side.

If you are in a top-ten state and your quote looks steep even against that high baseline, that is exactly the situation where a broker earns their fee. A broker who works your specialty and state can take your number to the carriers writing there now and come back with options you would not find on your own. Start from your state and specialty page for the filed benchmark, then let a broker shop it.

Broker match

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Common questions

What is the most expensive state for malpractice insurance?

Michigan, at a median filed rate of about $35,206 a year across 19 specialties, on a $1M/$3M mature claims-made basis. Illinois and New Jersey follow.

What is the cheapest state for malpractice insurance?

Wisconsin, at about $3,675, followed by Nebraska and Minnesota. The Upper Midwest and Plains states price at the low end.

How much does malpractice insurance vary by state?

The most expensive state runs about 9.6 times the cheapest on the same basis. A physician's state can affect their premium more than their specialty does.

Why is malpractice insurance so expensive in some states?

Legal and structural factors: whether the state caps noneconomic damages, the local tort and verdict environment, the presence of a patient compensation fund, and how many carriers compete there. It is not driven by the medicine.

Sources and method

• What we computed — The median filed rate for each of 51 jurisdictions, taken across all 19 specialty groups, then ranked; the top-to-bottom multiple is Michigan divided by Wisconsin
• Basis — $1M/$3M limits, mature claims-made, manual (pre-credit) rate, from carrier rate filings on record with state insurance departments (SERFF and state DOIs)
• Conversions — Occurrence filings are converted to a claims-made-equivalent mature rate before inclusion
• Coverage — 51 jurisdictions, 19 specialties, 969 cells, built from 1,739 filed carrier rates; each state median pools 19 specialty cells, which is why the ranking is steadier than any single cell
• Depth — 16 of the 51 jurisdictions rest on a single filed carrier and are marked; the rest carry two or more, and a few (Massachusetts, Pennsylvania, New York, California, Oklahoma, Texas) carry three or more
• Known limits — Single-carrier states are directionally sound but thinner; the caps and patient-compensation-fund descriptions here are general and directional

How we build the filed-rate benchmark

Disclaimer

This article is a market-data benchmarking resource derived from carrier rate filings on record with state insurance departments. It reports filed manual rates for comparison and education. It does not provide, and must not be relied upon as, insurance advice, a coverage recommendation, or a determination that any specific quote is fair or unfair. Healthcare DealHub reports filed data and can refer you to a licensed broker; it does not sell insurance. Your coverage decision is yours to make, with a licensed broker or advisor.