Long-Distance Medical Transport Cost in 2027: How to Price and Run Private Wheelchair and Stretcher Trips

A family calls: their mother is leaving the hospital for a rehab center 300 miles away, near her daughter, and she rides in a wheelchair. A trip like this loses money when the quote covers only the miles she rides. This page covers private-pay trips, where you set the price. Medicaid rides over long distances follow program rules, covered in the rural NEMT guide.

What a long-distance trip costs to run

A local ride is mostly loaded miles. A long one-way trip is half empty miles, one or two days of crew time, and sometimes a night away. Price every line separately, then quote one total.

Cost line	What drives it	Where to get the number
Crew time	Every hour from leaving the garage to getting back, for each person in the van	Your wage plus payroll taxes
Overtime	Hours past 40 in the driver’s workweek, paid at 1.5 times the regular rate	Your payroll for that week
Fuel	Miles both ways divided by the van’s miles per gallon	Your fuel log and the current pump price
Wear on the van	Tires, oil, repairs, and value lost per mile	Your cost per mile
Hotel	One room per crew member per night	Your hotel, or the federal lodging rate as a guide
Meals	Each crew member, each day away	Your policy, or the federal meal rate as a guide
Tolls and parking	The route both ways	The toll authority’s rates for your vehicle class
Profit	The margin you need on the whole trip	Your pricing policy

Three official numbers help. The General Services Administration’s fiscal 2027 rates for federal travelers, for trips from October 1, 2026 through September 30, 2027, are $113 a night for lodging and $68 a day for meals and incidentals in most of the continental United States (Per Diem Bulletin FTR 27-01, August 18, 2026). Higher rates apply in 295 listed areas, and meal rates run from $68 to $92. The U.S. average for regular gasoline was $4.465 a gallon in the week of September 28, 2026 (EIA, released September 29, 2026). And the IRS business standard mileage rate is 76 cents a mile for July 1 to December 31, 2026. It is a tax rate for cars, not a price, but a wheelchair van cost per mile far below it deserves a second look.

Crew time is the line owners most often get wrong. Under federal wage rules, a driver who drives, or a helper required to ride along, is working the whole time, except bona fide meal breaks or sleep in adequate facilities the employer provides (29 CFR 785.41). A second driver dozing in the passenger seat is still on the clock. A night in a hotel room you pay for is not.

Worked example: a 300-mile wheelchair trip

Here is the family’s trip priced three ways. The hotel and meal figures are the federal fiscal 2027 standard rates and the fuel price is the EIA average. Every other number is an example to replace with your own: a driver cost of $22 an hour with payroll taxes, a van that gets 16 miles per gallon, $0.30 a mile for wear, $25 in tolls, and a 50 mph average on the highway.

The trip: 10 miles from your garage to the hospital, 300 miles with the rider, and 300 miles home empty, 610 miles in all. Day one is 8 hours on duty: 20 minutes to the pickup, 30 minutes to load and secure, 6 hours of driving, two 20-minute stops for the rider, and 30 minutes to hand her off. The drive home is 6.5 hours with a fuel stop.

Line	Plan A: one driver, hotel, home next day	Plan B: two drivers, home the same day	Plan C: stretcher van, crew of two, hotel
Crew hours	14.5	29 (2 × 14.5)	29 (2 × 14.5)
Crew time at $22 an hour	$319.00	$638.00	$638.00
Fuel, 610 miles ÷ 16 mpg × $4.465	$170.23	$170.23	$170.23
Wear, 610 miles × $0.30	$183.00	$183.00	$183.00
Hotel at $113 a room	$113.00	$0	$226.00
Meals at $68 a person a day	$136.00	$136.00	$272.00
Tolls	$25.00	$25.00	$25.00
Cost to run	$946.23	$1,152.23	$1,514.23
Price at a 20% margin (cost ÷ 0.8)	$1,182.79	$1,440.29	$1,892.79
Price per mile the rider rides	$3.94	$4.80	$6.31

Plan A is the cheapest to run because only one person is paid while the van moves. Plan B gets the van back a day sooner, which matters if it has standing trips at home tomorrow, but the second driver’s riding time costs $319. Plan C is the same trip for a rider who must lie flat: New York’s policy manual requires at least two employees on a stretcher trip, and Virginia’s DMAS requirements seat the second crew member in the back with the rider. The Plan C column uses the wheelchair van’s running cost, so add more if your stretcher van costs more per mile.

Two costs can change the total. If 6.5 of the trip’s hours fall past 40 for the driver’s week, overtime at 1.5 times adds about $71.50 at the example rate. And a lone driver running the whole trip in one day would drive about 12 hours, past the 10-hour limit federal rules set for passenger-carrying commercial vehicles. Plan C is worth the extra only if the rider truly cannot sit up. The stretcher transport cost guide explains why, and the trip price calculator runs the margin math on any trip.

Crew rest and driver hours on long trips

Federal hours-of-service rules reach a medical trip only when the vehicle is a commercial motor vehicle on an interstate trip (49 CFR 390.5T): rated or weighing 10,001 pounds or more, or designed or used to carry more than 8 people, driver included, for pay. Then a passenger-carrying driver may drive no more than 10 hours after 8 consecutive hours off, may not drive after 15 hours on duty, and may not drive after 60 hours on duty in 7 days, or 70 in 8 days if you run every day (49 CFR 395.5).

Most wheelchair minivans fall outside those rules. Use the limits anyway as company policy, because fatigue on a long highway run puts the rider at risk. In practice:

• Plan the day around 10 hours of driving. If the round trip needs more, book a hotel or send two drivers.
• Count waits as duty time. A driver waiting at the destination for paperwork is still working.
• Give 8 hours off before the drive home, in a real room, not the van.
• Pay overtime. Drivers of vehicles rated 10,000 pounds or less keep their federal right to overtime even on interstate trips, unless the vehicle is designed or used for more than 8 people for pay (DOL Fact Sheet 19). Hours past 40 in a workweek are paid at 1.5 times the regular rate. See NEMT driver overtime.

The hours of service glossary entry explains the federal logbook and short-haul rules for vans that do count.

Rules for trips across state lines

A paid ride across a state line is interstate commerce, whoever pays for it. FMCSA says for-hire carriers operating in interstate commerce need operating authority registration “no matter how small or light the vehicle(s) used, unless exempted,” plus a USDOT number (Appendix A to 49 CFR part 390). The carrier must also file liability coverage of at least $1.5 million for vehicles seating 15 or fewer, driver included (49 CFR 387.33T). Get the authority before the first trip. The USDOT number guide covers the filings, fees, and exemptions step by step.

Watch the ride home. A second paying rider you pick up on the way back to your state keeps the trip interstate. A ride that starts and ends inside the other state never crosses a line, so it is intrastate commerce there under the definitions in 49 CFR 390.5T. That state’s for-hire rules apply, so check its permit requirements before you accept one.

Insurance is the other question. Ask your agent in writing whether your commercial auto policy covers private trips out of state, and at what limits. See NEMT insurance requirements.

Who pays for long-distance medical transport

Check every payer before you quote a family, because some payers bar you from charging the rider at all.

Payer	When it pays for a long trip	What it means for your quote
The rider or family	Any trip they choose to book	You set the price. Collect a deposit and put the terms in writing.
Original Medicare	Ambulance only, when any other vehicle could endanger the patient’s health, and only to the nearest facility able to give the needed care, or from a facility to home (42 CFR 410.40)	A wheelchair van trip, or a move to be near family, is usually private pay. See does Medicare cover NEMT.
Medicare Advantage	Only if the plan has a ride benefit, and plans can cap the distance. Humana’s 2026 plan H1036-324, for example, covers 24 one-way trips a year inside its service area, up to 50 miles each.	A long trip can fall outside the plan’s benefit, so check its Evidence of Coverage. See Medicare Advantage transportation.
Medicaid	Care in another state only in listed cases, such as an emergency or care more readily available there (42 CFR 431.52), and rides to covered care under the state’s rules	If Medicaid covers the ride, you must accept its payment as payment in full, plus any copay the state sets (42 CFR 447.15). See out-of-state NEMT trips.
A hospital or facility	Transfers it arranges and agrees to pay for	Get a written purchase order or agreement before you dispatch. See hospital discharge transportation.

Families often ask about taxes. IRS Publication 502 (2025) counts transportation primarily for and essential to medical care as a medical expense, and lodging away from home for care at a licensed hospital or similar facility up to $50 a night per person. An itemized receipt with the date, route, and total helps them, and it needs no diagnosis. For more on private riders, see private pay NEMT.

When a long trip needs an ambulance instead

A long ride magnifies any mismatch between the rider and your van. Screen for these before you quote:

• Care on the way. Virginia’s stretcher van rules bar riders who need close observation or medical monitoring, basic or advanced life support, or who have an IV, a saline lock, or an airway device in place. Those riders need an ambulance. See NEMT vs ambulance.
• Oxygen. Federal disability rules bar refusing a rider who travels with a portable oxygen supply, consistent with hazardous materials rules (49 CFR 37.167). Virginia’s stretcher vans may carry only oxygen the rider gives themselves, in a secured tank. Ask how many hours of supply the rider will bring, and plan for traffic.
• More than one stretcher. Virginia allows one stretcher passenger per van at a time, and the rider may never be left alone.
• Hours in one position. Ask whether the rider can sit that long. If not, the trip may belong in a stretcher van, and the stretcher van requirements apply.

Plan the stops too: medications due on the road, restroom access for a wheelchair user, meals, and a securement check each time the rider gets back in.

How to quote a long-distance trip, step by step

1. Get the details in writing. Pickup and drop-off addresses, date and time, how the rider moves (walks, wheelchair, or stretcher), weight with equipment, oxygen, stairs at either end, who rides along, and who receives the rider.
2. Map the route both ways. Count the empty return, tolls, and a realistic highway average.
3. Choose the crew plan. One driver with a hotel night, two drivers the same day, or a two-person stretcher crew.
4. Price the crew hours, including every minute from garage back to garage, and overtime if the week will pass 40 hours.
5. Add fuel, wear, tolls, hotel, and meals, using the lines in the table above.
6. Add your margin and quote one total. In California, offering a price that leaves out mandatory fees is a prohibited practice (Civil Code 1770(a)(29)), so fold fuel and other charges into the price. A single total is clearer everywhere.
7. Put the terms in writing. Deposit, when the balance is due, the cancellation fee, and what can change the price, such as a long delay at pickup. The NEMT rate sheet and invoice template have room for both.
8. Confirm the day before with the family and the receiving facility, including the time someone will be there to take the rider in.

For the pricing method behind each line, see how much to charge for NEMT.