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Short answer: one wheelchair van running 8 trips a day, 21 days a month, grosses about $7,500 to $9,700 a month depending on who pays for the trips. After a realistic cost stack of about $8,760, that van loses up to $1,200 a month or clears about $900. A small fleet that gets its payer mix and trip density right nets 8 to 15%, the same range as our trip-pricing analysis. Figures of 20 to 30% margins, or a flat "$2,500 to $4,700 per vehicle per month", are not built from anything you can check, and you should not plan a business around them.
This guide builds earnings from a model you can audit line by line: trips per day, revenue per trip by payer, and the monthly cost of keeping a van on the road. Every public number links to its source. Every assumption is labeled as one, so you can swap in your own.
How the model works
An NEMT company's monthly profit comes down to three inputs:
- Trips per vehicle per day. Completed one-way legs, not scheduled ones. A trip that is booked and then cancelled or no-showed costs driver time and usually earns little or nothing.
- Revenue per trip. Set by the payer: a state Medicaid fee schedule or broker contract, a facility contract, or your own private-pay rate card.
- Cost per vehicle per month. Driver time, fuel, maintenance, insurance, the vehicle payment, software and overhead. Most of it is owed whether the van runs 5 trips a day or 10.
Monthly profit per van = trips per day x operating days x average revenue per trip, minus the monthly cost stack. The rest of this page fills in each input.
What payers actually pay per trip
Medicaid fee schedules pay a base rate per one-way trip plus a rate per loaded mile, tiered by vehicle type. Here is what a 12-mile trip pays under four current published schedules:
| Schedule | Base per trip | Per loaded mile | 12-mile trip pays | Notes |
|---|---|---|---|---|
| Colorado Medicaid, ambulatory (A0120 + S0215), from July 1, 2026 | $12.15 | $2.74 | $45.03 if every loaded mile is paid | HCPF cut the rates to $12.40 and $2.80, then applied a 2% across-the-board cut after prior reductions. The base was $36.40 before July, according to KOAA. |
| Minnesota state-administered NEMT, wheelchair (A0130 + S0209), from July 1, 2026 | $19.80 | $1.80 | $41.40 | Minnesota DHS pays mileage from the first loaded mile and adjusts it quarterly for fuel. Rural add-ons apply in some ZIP codes. |
| North Dakota Medicaid, wheelchair van (A0130 + S0209) | $18.05 | $2.57 | $18.05 | Current schedule, data updated Sept. 27, 2026. The 2025 schedule paid wheelchair mileage only past 15 miles. If that rule still applies, a 12-mile trip pays the base alone. |
| South Dakota Medicaid, secure van (A0130 + S0209), from July 1, 2026 | $43.39 | $2.61 | $43.39 in town | South Dakota pays secure van mileage only outside city limits. Its in-city community transportation trip pays $5.20. |
Three things to take from the table:
- Read the threshold language. Mileage that starts at mile 15, or only outside city limits, turns a "base plus mileage" rate into a flat fee on the short trips that make up most urban volume.
- Rates move down as well as up. Colorado's ambulatory base fell by about two thirds in one budget cycle.
- Brokers and managed care plans set their own rates. Many states pay NEMT through a broker, and broker contract rates are often not published. Get yours in writing and model each contract separately.
The other two channels have no public schedule:
- Facility contracts (dialysis centers, adult day programs, hospitals, skilled nursing) are negotiated, usually as a flat rate per trip by vehicle type. Standing orders make them the most predictable volume you can get.
- Private pay is whatever your rate card says. Our trip-pricing analysis uses $125 for a private-pay wheelchair trip, and that is the figure used below. Check it against what operators in your market actually charge.
What one van costs to run each month
This is the same cost stack as our trip-pricing post: one wheelchair-accessible minivan in a small fleet, one driver on a 9-hour paid shift, 21 operating days a month. The fuel line is refreshed to the latest weekly price.
| Cost line | Monthly | Basis |
|---|---|---|
| Driver wages | $3,402 | $18.00 an hour x 9 hours x 21 days. The BLS May 2025 median for shuttle drivers and chauffeurs (SOC 53-3053) is $17.93 an hour nationally and $18.09 in the industry group that includes special needs transportation. |
| Payroll burden | $953 | Assumption: 28% for payroll taxes, workers' comp, unemployment insurance and paid time off. |
| Commercial auto insurance | $1,000 | Assumption: $12,000 a year. Premiums vary widely by state, vehicle type, limits and loss history. Use your own quote; our NEMT insurance guide covers what drives the price. |
| Fuel | $771 | 3,108 miles a month at 18 mpg x $4.465 a gallon, the EIA U.S. regular gasoline average for the week ending Sept. 28, 2026. |
| Maintenance, tires, ramp service | $497 | Assumption: 16 cents a mile x 3,108 miles. |
| Vehicle payment | $934 | Assumption: $45,000 used wheelchair conversion, 60 months, 9% APR. See what a medical transport van costs for new and used pricing. |
| Dispatch software and telematics | $100 | Assumption: per-vehicle software plus camera or GPS. |
| Allocated overhead | $1,100 | Assumption: this van's share of a dispatcher, biller, credentialing, drug and alcohol testing, accounting and office. |
| Total per van | $8,757 | $52.13 per completed trip at 8 trips a day; $4.34 per loaded mile. |
The mileage comes from 8 trips a day averaging 12 loaded miles, with deadhead at 35% of total miles: 96 loaded miles and 148 total miles a day. Deadhead is unpaid, and it is the single largest swing factor in cost per trip. The trip-pricing post shows how break-even moves when it changes.
To run this stack in our cost per trip calculator, enter 12 loaded and 6.5 deadhead miles per trip, an hourly wage of $18 with 67.5 paid minutes per trip and 28% payroll burden, $4.465 fuel at 18 mpg, $0.16 a mile maintenance, a $934 vehicle payment, $12,000 insurance, $1,200 overhead, 8 trips a day and 21 days. It returns the same $52.13 cost per trip.
Worked example 1: one van, the owner drives
Most single-van companies are owner-operators. The owner drives, takes the trip requests and does the billing at night. There is no hired driver and no dispatcher, so the cost stack drops to the lines the owner cannot do personally.
| Line | All broker or Medicaid volume | Hybrid book |
|---|---|---|
| Trips | 8 a day at $45 | 6 at $45, 1 facility at $65, 1 private pay at $125 |
| Revenue per month (21 days) | $7,560 | $9,660 |
| Non-labor costs: insurance, fuel, maintenance, vehicle payment, software | $3,302 | $3,302 |
| Owner-operator overhead (assumption: phone, accounting, testing program, permits) | $400 | $400 |
| Owner's take per month, before taxes | $3,858 | $5,958 |
| Per year | $46,296 | $71,496 |
| Per driving hour (189 hours a month) | $20.41 | $31.52 |
The $45 broker figure sits near the 12-mile trip in Colorado and Minnesota above. In North Dakota the same 8 trips would pay far less. The facility and private-pay rates are assumptions; replace them with your contracts.
Two things to notice. First, that take is not profit. It is pay for two jobs: driving, which a hired driver would cost $4,355 a month with burden, plus dispatch, billing and credentialing. On all-broker volume, the owner earns about $20 a driving hour, close to the $17.93 median wage for a hired driver, while also carrying the vehicle loan and the insurance policy. Second, those figures are before tax. A single-member LLC owner generally pays self-employment tax of 15.3% on 92.35% of net earnings, about $6,500 a year on the all-broker take and about $10,100 on the hybrid take, before income tax.
Worked example 2: five vans, the owner manages
At five vans, the owner usually stops driving. Five hired drivers, a dispatcher and a biller replace the owner's own labor. Each van carries the full $8,757 stack, including $1,100 of overhead, so the fleet's monthly cost is $43,785. The stack does not include a salary for the owner.
| Payer mix per van per day | Revenue per month (5 vans) | Profit per month | Net margin | Profit per year |
|---|---|---|---|---|
| 8 broker trips at $45 | $37,800 | -$5,985 | -16% | -$71,820 |
| 6 broker, 1 facility, 1 private pay | $48,300 | $4,515 | 9% | $54,180 |
| 5 broker, 2 facility, 1 private pay | $50,400 | $6,615 | 13% | $79,380 |
The fleet's profit is the owner's pay. With a hybrid book, five vans pay their owner $54,000 to $79,000 a year before tax, about what one van pays an owner who drives it with the same mix. The owner of five vans is trading driving hours for management, five vehicle notes and a payroll. That profit line is also where a buyer starts when pricing the company: see how NEMT company valuation works.
The five-van owner also carries working capital. If your broker pays 30 to 45 days after the trip, you fund one to one and a half months of costs before the first payment lands: about $44,000 to $66,000 at this fleet size. Growth on broker volume alone is a cash problem before it is a profit problem. Before you add van number two, three or six, run it through the vehicle break-even calculator to see how many trips a day it needs and how long it takes to pay back the down payment.
Why margins land at 8 to 15%
Hold the $8,757 stack fixed and move the two inputs you partly control. Each cell is monthly profit per van, then net margin:
| Average revenue per trip | 7 trips a day | 8 trips a day | 9 trips a day |
|---|---|---|---|
| $50.00 | -$1,407 (-19%) | -$357 (-4%) | $693 (7%) |
| $57.50 | -$304 (-4%) | $903 (9%) | $2,110 (19%) |
| $65.00 | $798 (8%) | $2,163 (20%) | $3,528 (29%) |
The grid explains the range. One trip a day, either way, moves a van from about 9% to a small loss or to 19%. A 20 to 30% margin needs something like 9 completed trips a day at a $65 average, every operating day, on a single 9-hour shift. That means low deadhead, few no-shows and a heavy private-pay or facility mix. At 8 trips a day and a mostly brokered book, the model lands in the 8 to 15% net range that our trip-pricing analysis reports, or below it.
Two break-even numbers to carry into every contract conversation:
- Per trip: $52.13 to break even at 8 trips a day; $56.66 for an 8% net margin; $61.32 for 15%.
- Per day: at a $57.50 average, a van needs about 7.3 completed trips a day to cover its stack. At a $45 average it needs about 9.3.
What changes the answer for your company
- Your state and your contracts. The same 12-mile trip pays $18.05 to $45.03 across the four schedules above. Price every contract against your own break-even, not against a state average.
- Deadhead. Standing orders and clustered pickups add trips without adding hours. Our trip-pricing post shows break-even per trip moving by about two thirds between 20% and 50% deadhead.
- Payer mix. In the model, moving one trip a day from broker to private pay is worth $1,680 a month per van.
- Your fixed lines. Insurance, the vehicle payment, software and overhead come to about $3,134 a month per van in this model, owed whether the van runs or sits.
- Startup costs. Licensing, enrollment, vehicle conversion and the months before volume arrives come before any of this. Our guide to starting a medical transportation business covers them.
To use these numbers:
- Rebuild the cost stack with your payroll, your insurance declarations page and your vehicle note. Do not use the assumptions here as your figures.
- Pull one month of completed trips per van per day and your real deadhead ratio from dispatch.
- Run each contract through the cost per trip calculator at its actual paid rate and average trip length, and rank them.
- Renegotiate, narrow the service area or exit anything below break-even, and fill the open slots with facility and private-pay trips.
Frequently asked questions
How much does an NEMT business make per month?
Per wheelchair van running 8 trips a day, 21 days a month, gross revenue is about $7,560 on all-broker volume at $45 a trip and about $9,660 with a mix of broker, facility and private-pay trips. Against a cost stack of about $8,757 per van with a hired driver, that is a monthly loss of about $1,200 or a profit of about $900. Your state's fee schedule, your contracts and your trips per day change the answer more than anything else.
What is a realistic profit margin for an NEMT company?
For a small fleet with hired drivers, plan on 8 to 15% net in a good year, the range in our trip-pricing analysis. All-broker volume in a low-rate state can run at a loss. Margins of 20 to 30% require 9 or more completed trips a day per van at an average rate well above most Medicaid schedules.
How much can a single-van NEMT owner make?
In the model, an owner who drives the van and does the dispatch and billing takes home about $46,000 a year before taxes on all-broker volume, and about $71,000 with a mix that includes facility and private-pay trips. That is pay for driving plus running the office. Self-employment tax and income tax come out of it.
How many trips a day does an NEMT van need to break even?
With a monthly stack of $8,757 and 21 operating days, a van needs about 7.3 completed trips a day at a $57.50 average, or about 9.3 at a $45 average. Enter your own rates and costs in the cost per trip calculator to get your number.
Is broker volume or private pay more profitable?
Per trip, private pay and facility contracts clear far more margin. Broker and Medicaid trips bring volume, but in several states the published rate for a short trip sits below the $52 cost per trip in this model. The profitable cases in this model use broker trips as base load and facility and private-pay work for margin.
Rates, broker changes and the math behind them land in The NEMTrepreneur Dispatch every Tuesday. Subscribe free.
