# How Much to Charge for NEMT Rides in 2027: A Private-Pay Pricing Method

Canonical URL: https://nemtguide.com/guides/how-much-to-charge-for-nemt/ · Updated 2026-09-28

Charge private-pay NEMT riders a base fee per trip, a rate per loaded mile, and a wait rate, each built from what an hour of your van and a mile of driving cost you, plus your profit margin. Add set fees for extra help and a second crew member. With the example costs on this page, a 12-mile wheelchair ride prices at $66.10 one way.

- Price every private ride from your own costs: an hour of van and driver time, and a mile of driving.
- Put the drive to the pickup, loading, and securing into the base fee, because every trip needs them.
- Charge for waiting by the quarter hour. Your driver is paid while waiting, and the van earns nothing.
- A 20% margin means dividing your cost by 0.8, not adding 20% to it.
- You cannot charge a Medicaid member for a covered ride or a no-show. Private pricing is for riders and payers outside Medicaid.

Medicaid and brokers tell you what a ride pays. Private riders, families, and facilities ask you to name the price. The safest way to set it is from the bottom up: work out what an hour and a mile cost your company, then add the profit you need. This page walks through that method with one worked example you can copy with your own numbers.

## Who pays private rates, and who you cannot charge

Private-pay rides come from people and organizations outside the Medicaid program, or rides Medicaid does not cover:

- **Seniors and families.** Original Medicare's ride benefit is ambulance transportation. Part B covers ground ambulance transportation when traveling in any other vehicle could endanger the rider's health. A rider who can travel safely in a wheelchair van or car falls outside that benefit.
- **Facilities.** Assisted living communities, nursing homes, dialysis centers, and hospitals may book rides for residents or for patients going home. Offer them a written rate and a monthly invoice. See [NEMT facility contracts](https://nemtguide.com/guides/how-to-get-nemt-facility-contracts/) and the facility transportation agreement template.

Medicaid members are different. Under [42 CFR 447.15](https://www.ecfr.gov/current/title-42/section-447.15), a Medicaid provider must accept the Medicaid payment as payment in full for a covered service. CMS adds that providers may not charge a Medicaid member for no-shows (SMD 23-006, September 28, 2023), and New York's transportation manual says drivers and providers never ask members for payment. Keep your private rate sheet for private work.

Your state may regulate these prices too. In Connecticut, the Commissioner of Public Health sets rates for licensed ambulance services and invalid coaches, the state's term for vehicles that carry nonambulatory riders who are not on stretchers (Connecticut General Statutes 19a-175 and 19a-177). For 2026, a service could raise its approved rates by up to 2.1 percent with a short-form application. Check your state's transportation or health department rules before you publish prices.

## The parts of a NEMT price

A clear private price has three core parts and a short list of add-ons. Keep the names simple so a rider can compare your quote with others.

| Part | What it covers | How you set it |
|---|---|---|
| Base fee | Driving to the pickup, loading and securing, unloading, and paperwork | Average minutes and empty miles per trip, times your cost |
| Mileage rate | Each loaded mile | Vehicle running cost plus driver time per mile |
| Wait rate | Time the van and driver sit idle for the rider | Your cost per van hour, charged per 15 minutes |
| Extra help | Door-through-door help, stairs, a second crew member | The added minutes or the added person, times your cost |
| Special trips | After hours, long distance, same day | The overtime, extra miles, or lost trips they cause |

## Step 1: Find your cost for one hour of van and driver

Every minute a rider needs costs you driver pay and a share of your fixed costs. Add them into one hourly number.

**Driver cost per hour.** Start with the wage. Add the employer's share of Social Security and Medicare, 6.2 percent plus 1.45 percent, or 7.65 percent (IRS Topic 751). Then add workers' compensation, federal and state unemployment tax, and paid time off, from your own bills. Waiting counts: under [29 CFR 785.15](https://www.ecfr.gov/current/title-29/section-785.15), an employee who waits while on duty is working, and time counts as off duty only when the driver is completely relieved, told in advance when to return, and free long enough to use the time for personal purposes (29 CFR 785.16).

**Fixed cost per van hour.** Add up one month of costs that do not change with miles for one van: the loan or lease payment, commercial auto insurance, dispatch and phone costs, office rent, and admin pay. Divide by the hours the van is in paid service each month, meaning the hours it carries riders or drives to them.

Here is an example. These numbers are for illustration, not averages.

| Line | Example math | Example result |
|---|---|---|
| Driver wage | $18.00 an hour | $18.00 |
| Employer Social Security and Medicare | $18.00 × 7.65% | $1.38 |
| Workers' comp, unemployment, paid time off | From your own bills | $2.62 |
| Driver cost per hour | $18.00 + $1.38 + $2.62 | $22.00 |
| Fixed costs for one van | $4,200 a month ÷ 140 paid service hours | $30.00 |
| **Cost per van hour** | $22.00 + $30.00 | **$52.00** |
| Cost per minute | $52.00 ÷ 60 | $0.867 |

The [driver cost calculator](https://nemtguide.com/tools/nemt-driver-cost-calculator/) can help with the first four lines.

## Step 2: Find your cost for one mile

Your cost per mile is what the van burns and wears out on each mile: fuel, tires, oil, brakes, and repairs. Leave insurance and loan payments in the fixed costs above so nothing is counted twice.

**Fuel.** Divide the price per gallon by your van's miles per gallon. The U.S. average retail price for regular gasoline was $4.478 a gallon for the week of September 21, 2026, up $1.305 from a year earlier (EIA). A van that gets an example 14 miles per gallon burns $4.48 ÷ 14, or $0.32, a mile.

**Everything else.** Add up tires, oil changes, and repairs over several months and divide by the miles driven. Repairs come in lumps, so a longer period gives a truer number. The example uses $0.18 a mile.

| Line | Example math | Example result |
|---|---|---|
| Fuel | $4.48 a gallon ÷ 14 miles per gallon | $0.32 |
| Tires, maintenance, repairs | From your own records | $0.18 |
| **Cost per mile** | $0.32 + $0.18 | **$0.50** |

The IRS business standard mileage rate is 76 cents a mile for July 1 through December 31, 2026, up from 72.5 cents in the first half of the year. It is a tax deduction rate, not a price, and it leaves out driver pay. The IRS also does not allow it for five or more cars operated at the same time, as in a fleet (Topic 510). On a tax return it takes the place of actual car expenses such as gas, repairs, insurance, and depreciation, so expect it to run above a per-mile cost that keeps insurance and the van payment in fixed costs. The [cost per mile calculator](https://nemtguide.com/tools/nemt-cost-per-mile-calculator/) does this math for you.

## Step 3: Turn the costs into a base fee, mile rate, and wait rate

Now split the costs the way a trip uses them.

**Base fee cost = (minutes to reach the pickup + minutes to load + minutes to unload) × cost per minute + empty miles to the pickup × cost per mile**

**Mile rate cost = minutes per loaded mile × cost per minute + cost per mile**

**Wait cost per 15 minutes = cost per van hour ÷ 4**

Measure the inputs from your own trips for a few weeks. For the example: the van takes 12 minutes and 5 empty miles to reach a typical pickup, 10 minutes to load and secure a wheelchair, and 5 minutes to unload. It averages 30 miles an hour with a rider, or 2 minutes a mile.

| Part | Example math | Example cost |
|---|---|---|
| Base fee | (12 + 10 + 5) minutes × $0.867 + 5 miles × $0.50 | $25.90 |
| Mile rate | 2 minutes × $0.867 + $0.50 | $2.23 |
| Wait, per 15 minutes | $52.00 ÷ 4 | $13.00 |

Empty miles belong in the base fee. Every trip starts with a drive to the pickup, and one clear pickup fee is easier for a rider to accept than a separate empty-mile charge. See [deadhead miles](https://nemtguide.com/glossary/deadhead-miles/) for how to track them.

## Step 4: Add your profit margin

Margin is profit as a share of the price. To keep a 20 percent margin, divide each cost by 0.8. Adding 20 percent to the cost, a markup, leaves you only about 16.7 percent.

**Price = cost ÷ (1 minus margin)**

| Part | Example cost | Price at a 20% margin | Rounded price |
|---|---|---|---|
| Base fee | $25.90 | $25.90 ÷ 0.8 = $32.38 | $32.50 |
| Mile rate | $2.23 | $2.23 ÷ 0.8 = $2.79 | $2.80 |
| Wait, per 15 minutes | $13.00 | $13.00 ÷ 0.8 = $16.25 | $16.25 |

Round up to an easy number, like the nearest 50 cents on the base and 5 or 10 cents on the mile. The [trip price calculator](https://nemtguide.com/tools/nemt-trip-price-calculator/) runs the same margin math on a single trip.

## Step 5: Price extra help and special trips

Each add-on is the extra time or the extra person it takes, priced the same way.

- **Door-through-door help or stairs.** If helping a rider inside or up a flight of stairs adds 15 minutes, that is $13.00 of cost and $16.25 at a 20 percent margin in the example.
- **A second crew member.** Add the second person's hourly cost for the whole trip. At the example $22.00 an hour, that is $27.50 an hour at a 20 percent margin.
- **After hours and weekends.** For most employees, federal law requires at least one and a half times the regular rate for hours over 40 in a workweek (29 CFR 778.101 and 778.107). If night or weekend rides push drivers into overtime, price the extra pay into those rides.
- **Long distance.** Long private trips add driver rest, meals, and sometimes a hotel. See long-distance medical transport.
- **Cancellations and no-shows.** For private riders, a late cancellation fee covers a van you held and could not fill. Put the rule in writing. The [no-show policy template](https://nemtguide.com/templates/nemt-no-show-policy/) has a model.

Wheelchair and stretcher rides take more loading time and equipment, so give each level of service its own base fee and mile rate. A stretcher ride that needs two people and more loading time should never share the wheelchair price. See wheelchair transportation cost and stretcher transport cost.

## Worked example: a 12-mile wheelchair ride

A family books a wheelchair ride to a clinic 12 miles away. The appointment runs an hour, and the driver waits. The first 15 minutes of waiting are free.

| Line | Math | Price |
|---|---|---|
| Base fee, trip to the clinic | 1 × $32.50 | $32.50 |
| Loaded miles, trip to the clinic | 12 × $2.80 | $33.60 |
| **One-way total** | | **$66.10** |
| Waiting, 60 minutes less 15 free | 3 × $16.25 | $48.75 |
| Base fee and miles, trip home | $32.50 + $33.60 | $66.10 |
| **Round trip with waiting** | $66.10 + $48.75 + $66.10 | **$180.95** |

Check the margin on the one-way trip. It costs $25.90 plus 12 × $2.23, or $52.66, and sells for $66.10. That leaves $13.44, which is 20.3 percent of the price.

If the driver goes on to another paid ride during the appointment instead of waiting, drop the wait charge. The return trip still carries its own base fee, because the van has to come back.

## Check your price against Medicaid rates

Medicaid fee schedules show what one large payer pays for the same ride. They are not a price to copy, because they generally pay for loaded miles only. Here is the same 12-mile one-way wheelchair ride at fee-for-service rates.

| Program | Rate | 12-mile ride pays |
|---|---|---|
| Indiana, January 1, 2026 | $31.79 + $1.67 a mile after the first 10 | $35.13 |
| Louisiana, October 1, 2025 schedule | $21.50 + $1.30 a mile | $37.10 |
| Medi-Cal, daytime, rate page updated September 2023 | $20.30 + $1.50 a mile | $38.30 |
| Ohio, since January 1, 2024 | $31.00 + $1.30 a mile | $46.60 |
| Nebraska, July 1, 2026 | $46.12 + $1.85 a mile after the first 5 | $59.07 |
| New York City, April 2026 schedule | $52.90 + $3.60 a mile | $96.10 |

At the example cost of $52.66, most of these rates pay less than the trip costs. Medicaid work can still pay when vans stay full and empty miles stay low, which is why private rides and facility contracts matter for your margin. The full state table is in [NEMT reimbursement rates](https://nemtguide.com/guides/nemt-reimbursement-rates/).

Before you publish your prices, ask two or three local companies for a quote on the same trip. If your price is far higher, look first at your empty miles and your paid service hours per van.

## Put your prices in writing and keep them current

1. **Make a one-page rate sheet** for each level of service, with the base fee, mile rate, wait rate, add-ons, and cancellation rule. Start from the [rate sheet template](https://nemtguide.com/templates/nemt-rate-sheet/).
2. **Quote before the ride.** Give the rider or facility the total for the planned trip, and say what can change it, such as a longer wait.
3. **Give an itemized receipt.** IRS Publication 502 (2025) counts amounts paid for transportation primarily for and essential to medical care as a medical expense. List the date, the pickup and drop-off, and each charge, and leave out health details.
4. **Make payment easy.** Offer card payment at booking for families and a monthly invoice for facilities. See taking payment for private-pay rides.
5. **Set a fuel rule.** Write down how your mile rate moves with gas prices, and check the EIA weekly price. Minnesota's Medicaid program does this for ambulance mileage. In each quarter when gasoline tops $3.00 a gallon, it moves the mile rate 1 percent for every 10 cents the average Minnesota price for all grades sits above or below $3.00, using EIA prices (Minnesota Statutes 256B.0625, subdivision 17a).
6. **Review everything once a year.** New insurance premiums, wage changes, and a new van all change your hourly cost. Rerun steps 1 through 4 with the new numbers.

For more ways to find and keep private riders, see [how to grow private-pay NEMT rides](https://nemtguide.com/guides/private-pay-nemt/).

## Frequently asked questions

### How much should I charge for a wheelchair van ride?

Start from your costs, not a competitor's price list. With the example costs on this page, $52 an hour for van and driver and 50 cents a mile to run the van, a 20% margin gives a $32.50 base fee plus $2.80 a loaded mile. A 12-mile one-way ride comes to $66.10. Put your own numbers in the same steps.

### Should I charge for the miles I drive to the pickup?

Yes, but put them in the base fee instead of billing them as a separate line. Riders understand one pickup fee better than an empty-mile charge. Build the base fee from your average drive to a pickup, in minutes and miles, plus loading and unloading time. Medicaid generally pays loaded miles only, so private rides are where you recover those empty miles.

### Can I charge a Medicaid member for a ride or a no-show fee?

Not for a ride Medicaid covers. Under 42 CFR 447.15, a Medicaid provider accepts the Medicaid payment as payment in full, and CMS says providers may not charge a Medicaid member for no-shows. New York's transportation manual adds that providers never ask members for payment. Private-pay prices apply to riders and payers outside the Medicaid program.

### How do I price waiting time?

Charge by the quarter hour after a short free period, using your cost for an hour of van and driver time. Federal wage rules count on-duty waiting as work time, so you pay the driver whether the van moves or not. With the example $52 an hour cost and a 20% margin, waiting prices at $16.25 per 15 minutes.

### Can I use the IRS mileage rate as my per-mile price?

Use it only as a rough check. The IRS business standard mileage rate is 76 cents a mile for July 1 through December 31, 2026. It is a tax deduction rate, it does not include driver pay, and the IRS does not allow it for five or more cars operated at the same time. Your own fuel and repair costs give a better number.

### How often should I change my NEMT prices?

Review them at least once a year and whenever fuel moves a lot. The U.S. average price for regular gasoline was $4.478 a gallon for the week of September 21, 2026, up $1.305 from a year earlier. A written fuel rule, such as adjusting the mile rate for every 10 cents gas moves, lets you change prices without renegotiating each time.

## Official resources

- [IRS: Standard mileage rates](https://www.irs.gov/tax-professionals/standard-mileage-rates)
- [EIA: Weekly retail gasoline and diesel prices](https://www.eia.gov/petroleum/gasdiesel/)
- [IRS: Topic no. 751, Social Security and Medicare withholding rates](https://www.irs.gov/taxtopics/tc751)
- [eCFR: 29 CFR 785.15, On duty (waiting time is work time)](https://www.ecfr.gov/current/title-29/section-785.15)
- [IRS: Publication 502, Medical and Dental Expenses](https://www.irs.gov/publications/p502)
- [Medicare.gov: Ambulance services coverage](https://www.medicare.gov/coverage/ambulance-services)