How Much Does Tail Coverage Cost? What Carriers Publish, What Physicians Pay in Eight Markets, and When the Bill Is Zero

Most articles about tail coverage give a specialty table with no source. This one starts from two things that are published: what the carriers say about how they price tail, and what physicians in eight markets pay for the underlying policy, as reported by the American Medical Association from the Medical Liability Monitor rate survey. The estimates below are arithmetic on those two inputs, and the page says so where it is arithmetic. For what tail is and who should pay for it, read the companion tail coverage guide.

How tail is priced

A claims-made policy covers incidents that both happen and are reported while it is in force. When it ends, tail, formally an extended reporting endorsement, keeps the reporting window open for incidents that happened before the end date. The carrier prices that window as a multiple of the premium you were paying when the policy ended.

• •The Doctors Company: tail costs “could range from a full year’s annual premium to a multiple of your annual premium,” and the extension “may be indefinite, or it may be for a predetermined term.”
• •MedPro Group: tail for a claims-made policy “can be a significant expense, sometimes twice the cost of your annual premium,” and occurrence coverage, which needs no tail, can be “less expensive overall once the tail coverage from a Claims-made policy is factored in.”
• •Brokers who quote tail (Cunningham Group, DHIA) describe a one-year reporting period at roughly 100% of the expiring premium and an unlimited tail at 200% to 300%.

Two words in those statements matter. “Annual premium” means the premium at the end, not the first-year rate. Claims-made pricing is stepped: year one is cheap because there is little prior exposure to report, and the rate climbs each year to a mature level around year five. The tail is priced off the mature rate. “Multiple” means the number depends on how long the reporting window stays open; an unlimited tail costs more than a one- or three-year one, and a claim that arrives after a limited tail expires is uncovered.

The premiums it’s based on

The AMA’s April 2026 Policy Research Perspectives report reproduces manual premiums from the Medical Liability Monitor’s annual rate survey for three specialties in eight markets, for $1 million/$3 million limits, from one insurer per market with continuous data. These are the 2025 figures.

The spread is the point. A general surgeon in Miami-Dade pays about six times what one in Los Angeles pays, and an OB/GYN in Illinois pays about four times an OB/GYN in California, where a cap on non-economic damages holds premiums down. The AMA also reports that nearly 40% of premiums it tracked rose in 2025, the seventh straight year of increases, with Pennsylvania, Kentucky, Florida, Illinois, and New York seeing large jumps two years running. A tail bought in 2027 will be priced on a higher premium than the table shows.

What tail costs, by market

Applying the carriers’ range, one to three times the annual premium, to the 2025 figures gives the following. The low end is a one-year reporting window at a full year’s premium; the high end is an unlimited tail at three times. Most physicians buying an unlimited tail should expect the upper half of each range.

What moves the price

• •Length of the reporting window. One year costs about a year’s premium; unlimited costs two to three times. Statutes of limitations for malpractice run two to three years in most states, longer for minors and for discovery of injury, so a short tail is a bet on the calendar.
• •Years on the policy. A physician leaving in year two is charged off a premium that hasn’t matured, so the tail is smaller in dollars than one bought in year six, even at the same multiple.
• •Limits. The AMA figures are for $1M/$3M. A $2M/$6M policy, common in some hospital contracts, carries a higher premium and a proportionally higher tail.
• •Specialty class. Internal medicine, general surgery, and OB/GYN bracket the market. Psychiatry and pediatrics price below internal medicine; neurosurgery prices with or above OB/GYN.
• •State and county. Same specialty, same carrier, and Miami-Dade costs six times Los Angeles. Pennsylvania adds a Patient Compensation Fund surcharge that is part of the premium the tail is computed on.
• •Claims history. Open claims or prior payouts raise the premium and can raise the multiple; a carrier can also decline a tail to a physician it is non-renewing.
• •Employer group rating. A health system’s group policy is often rated below the manual premium, which lowers the tail if the contract prices it off the actual premium rather than a manual rate.

When it’s free

Every major carrier waives the tail in some circumstances. The rules differ, and the differences are worth real money near retirement.

The common thread: free tail rewards staying with one carrier and leaving medicine entirely. A physician who switches carriers every renewal to save a few hundred dollars can forfeit a retirement tail worth a year or two of premium. A physician who retires at 62 after four years with a carrier that requires five gets nothing. Check the vesting clock before you change carriers or set a retirement date.

Paying for it

Tail is due when the policy ends, and it is usually a lump sum. ISMIE says tail “is generally not offered with a carrier-administered payment plan,” though outside premium financing is typically available. The Doctors Company says its tail “can be spread over two years without interest.” Ask your carrier which applies before you give notice, because the check is often due within 30 to 60 days of the policy ending.

Who writes the check is a contract question, and it is the one to settle before you sign. Employer pays in all cases, employer pays if it terminates you without cause, a vesting schedule that shifts the cost to the employer over years, or physician pays: those are the four common outcomes, and the difference between the first and the last is the whole table above. Our guide to physician contract red flags has the clause language, and contract review services will flag it for a few hundred dollars.

Avoiding the bill

• •Nose coverage. If the next job is also claims-made, the new carrier can extend its retroactive date back to cover your prior acts. That folds the old exposure into the new premium instead of a lump sum. It depends on the new carrier’s willingness and your claims history, and it does nothing for a physician who is retiring. ISMIE warns that leaving without tail and without full prior-acts coverage is “going bare.”
• •An occurrence policy. Covers any incident that happened while the policy was in force, whenever it is reported, so there is no tail. MedPro’s own comparison says occurrence is more expensive at first and often cheaper overall. Not every carrier offers it in every state. The trade-off is in claims-made vs. occurrence.
• •Staying long enough to vest. If you are within a few years of a carrier’s free-tail threshold, the value of waiting can exceed a year’s salary difference.

Getting a real quote

• 1.Get your current declarations page. It shows the carrier, limits, retroactive date, and the annual premium. If your employer holds the policy, HR or the practice administrator has it, and you are entitled to see it.
• 2.Ask the carrier for a written tail quote for an unlimited reporting period and, separately, for one and three years. Carriers quote tail on request for any in-force policy.
• 3.Ask the prospective new employer’s carrier whether it will write prior-acts coverage back to your retroactive date, and at what premium.
• 4.Put the number in the negotiation. A tail quote turns “physician is responsible for tail” from an abstraction into a dollar figure the employer can be asked to share.

The carriers themselves are compared in our malpractice insurance review, and surgical premiums specifically in what surgeons pay for malpractice insurance.