NEMT Break-Even Calculator (2027): How Many Trips You Need Each Month

What the break-even calculator does

Your break-even point is the number of trips a month that pays for everything, with nothing left over and nothing short. The SBA defines it as the point where total cost and total revenue are equal, and gives the formula as fixed costs ÷ (price minus variable costs).

For a NEMT company, the unit is one paid trip. Every trip pays you something and costs you something to run. What is left goes toward the bills that stay the same every month: insurance, loan payments, rent, and salaries. Once enough trips have covered those bills, every trip after that adds profit.

Use it before you open, before you add a van, and before you sign a contract at a new rate. The answer tells you whether the plan can work at all, and how busy the schedule has to be.

How to use the calculator

1. Enter your monthly fixed costs.
2. Enter what an average trip pays you, mileage included. Count each one-way ride as one trip, so a round trip is two.
3. Enter the average miles one trip puts on the vehicle, empty miles included.
4. Enter what a mile of driving costs you in fuel, tires, and repairs.
5. Enter the driver cost for one trip.
6. Enter the days a month you run trips.

The results change as you type. Reset to example puts the example numbers back, and Show the formula lists every step of the math.

What each number means

Box	What to enter	Where to find it
Monthly fixed costs	Costs that stay the same however many trips run	Insurance, loan and lease payments, rent, phone, software, office pay, and your own pay
Average pay per trip	What one trip pays you, mileage included	Last month’s payments for trips ÷ trips paid
Miles per trip	Miles one trip puts on the vehicle	Last month’s odometer miles ÷ trips paid
Vehicle cost per mile	Fuel, tires, and repairs for each mile	Several months of those bills ÷ the miles driven
Driver cost per trip	Driver pay and payroll taxes for one trip	A month of driver payroll ÷ trips paid
Working days a month	Days you run trips	Your schedule

Dividing by trips paid does two jobs at once. The empty drive to each pickup and the drive out to a rider who never came both land in the cost of the trips that did pay.

Sort fixed and per-trip costs

The SBA describes fixed costs as costs that do not change as production goes up or down, and lists rent, salaries, property taxes, insurance, interest, and depreciation as examples. If a bill comes every quarter, the SBA says to divide it by four. Divide a yearly insurance premium by 12 the same way.

Some bills are both. The SBA calls these semi-variable costs, lists phone service, repairs, and fuel among its examples, and suggests splitting each into its fixed and variable parts. A phone plan’s set monthly charge is fixed. Fuel and wear that rise with every mile go in vehicle cost per mile. Put each dollar in one place only, or the calculator counts it twice.

Put your own pay in fixed costs if you need the business to pay you. Without it, the answer is the point where the company pays its bills, not the point where it pays you.

Find your pay per trip in a fee schedule

Medicaid fee schedules such as Arizona’s pay a base rate for each trip plus a rate for each loaded mile, the miles with the member on board. Arizona’s fee-for-service rates effective October 1, 2026, for trips that start in the Phoenix or Tucson metro areas, show how to turn a schedule into one number. Each row is a 10-mile trip.

Type of trip	Base rate	10 loaded miles	Pay per trip
Ambulatory (A0120 plus S0215)	$6.64	10 × $1.28 = $12.80	$19.44
Wheelchair van (A0130 plus S0209)	$11.15	10 × $1.54 = $15.40	$26.55
Stretcher van (T2005 plus T2049)	$49.09	10 × $1.54 = $15.40	$64.49

Brokers and health plans set their own rates in their contracts, so use the rates you are actually paid. The guide to NEMT reimbursement rates shows where to find them for your state. The SBA suggests doing the math for each product or service when their sales vary from month to month, so if you run more than one type of trip, run the calculator once for each.

The empty miles are yours to carry. CMS says miles with no member on board generally cannot be paid, though states may build their cost into the rate (SMD 23-006, September 28, 2023). Arizona’s manual, revised July 31, 2026, bars any claim for unloaded mileage. The glossary entry on deadhead miles explains how they add up.

A no-show usually pays nothing either. CMS says federal Medicaid funds are not available for a trip to a member who does not appear, and neither states nor providers may charge the member for it.

Vehicle cost per mile and the IRS rate

Enter only what each mile burns and wears out. For fuel, divide the price of a gallon by your miles per gallon. The U.S. average for regular gasoline was $4.478 a gallon for the week of September 21, 2026 (EIA). At an example 15 miles per gallon, that is about 30 cents a mile before tires and repairs.

Do not enter the IRS standard mileage rate here if your loan, lease, and insurance are already in fixed costs. The business rate is 72.5 cents a mile for January 1 to June 30, 2026, and 76 cents from July 1, 2026, a change the IRS tied to recent increases in the price of fuel (Announcement 2026-11). The IRS sets it from an annual study of the fixed and variable costs of running a car, and 35 cents of the 2026 rate is treated as depreciation (Notice 2026-10). The cost per mile calculator compares your own vehicle cost with the IRS rate.

Driver cost per trip

Start with what the driver earns for the time one trip takes. Then add your share of payroll taxes. In 2026 the employer pays 6.2% Social Security tax on wages up to $184,500 and 1.45% Medicare tax on all wages, 7.65% in all (IRS Publication 15). Federal unemployment tax is 0.6% of the first $7,000 of each employee’s wages when you get the full state credit.

For example, a driver paid $18 an hour who spends 45 minutes on a trip earns $13.50 for it. Your 7.65% adds $1.03, so the trip costs $14.53 before unemployment taxes and workers’ compensation. Workers’ compensation and state unemployment rates vary by state.

A worked example

The calculator opens with example numbers. They show how the math works. They are not market rates, so replace them with your own.

Step	Math	Result
Cost of one trip	15 miles × $0.60 + $15 driver cost	$24.00
Left from each trip	$45 pay minus $24 cost	$21.00
Trips you need each month	$6,300 fixed costs ÷ $21	300 trips
Trips each working day	300 trips ÷ 22 days	13.6 trips
Monthly revenue to break even	300 trips × $45	$13,500

At 300 trips the business covers its costs and makes no profit. Trip 301 adds $21 of profit, and so does every trip after it.

What moves the answer most

What is left from each trip drives everything. The two tables below keep every other box at its example value and change one number at a time.

Pay per trip	Left from each trip	Trips a month	Trips a working day
$35.00	$11.00	573	26.0
$40.00	$16.00	394	17.9
$45.00	$21.00	300	13.6
$50.00	$26.00	243	11.0
$55.00	$31.00	204	9.3

A $5 cut in pay per trip adds 94 trips a month to the example. Check a new rate here before you accept it.

Miles per trip	Cost of one trip	Left from each trip	Trips a month
10	$21.00	$24.00	263
15	$24.00	$21.00	300
20	$27.00	$18.00	350
25	$30.00	$15.00	420

Five more empty miles on every trip adds 50 trips a month. Grouping pickups by area and planning return legs before the day starts cuts miles per trip without adding a ride.

How long until a new van pays for itself

A second van adds its own fixed costs and its own trips. It pays for itself once the profit from its trips has covered the cash you put into it. Two formulas do the work:

Monthly profit from the van = trips it runs a month × what is left from each trip, minus the van’s own fixed costs a month

Months to pay back the van = cash you put into the van ÷ monthly profit from the van

Here is an example van bought for $36,000 in cash, with $500 a month of its own insurance and other fixed costs. It runs 6 trips a day for 22 days, with the same $21 left from each trip as the worked example.

Step	Math	Result
Trips the van runs a month	6 × 22	132 trips
Left from its trips	132 × $21	$2,772
Monthly profit from the van	$2,772 minus $500	$2,272
Months to pay back the van	$36,000 ÷ $2,272	15.8 months

To see the trips the van needs just to cover its own costs, enter only its $500 of fixed costs in the calculator. It shows 24 trips a month, or 1.1 each working day.

If you finance the van, the loan payment joins its monthly fixed costs, and the cash you put in is the down payment plus anything else you paid up front, such as equipment. The vehicle loan calculator works out the payment and the trips it takes to cover it. If the new van needs a salaried driver, add that salary to its fixed costs too. A new van may take a while to fill its schedule, so count the payback from the month it runs full. The guide to starting with one van covers when the second one makes sense.

How to use the answer

• Set a daily target. The trips each working day number is a goal dispatch can check every afternoon.
• Check your fleet. Compare the daily number with how many trips your vehicles can run in a day. If you need 13.6 a day and one van can run 8, one van is not enough, and a second van adds to your fixed costs. The fleet size calculator works out how many you need.
• Plan your cash. Break-even trips are paid later. MTM Health’s standard agreement, in the January 1, 2023 version Pennsylvania posts, pays uncontested invoices within 30 days of electronic submission and refuses claims sent more than 90 days after the ride, or after the limit its client sets. The months it takes to grow to break-even, plus that wait, are months your reserve has to cover. The cash reserve calculator and the guide to NEMT cash flow show how much to hold.
• Add a cushion. The SBA suggests adding about 10% to cover expenses you cannot predict. In the example, $6,930 of fixed costs takes 330 trips a month.
• Price private work. Raise the average pay per trip to see how many fewer trips you need. The trip price calculator helps set private-pay rates.

Mistakes that throw the answer off

• Counting only loaded miles. The van drives to every pickup, and Medicaid generally pays only for the miles with the member on board. Divide all the miles by the trips paid.
• Using what you billed instead of what you were paid. A denied claim pays nothing. MTM’s standard agreement also withholds pay, or charges a penalty, when a late pickup makes a member miss the appointment, and pays nothing for rides by uncredentialed drivers or vehicles.
• Counting a cost twice. An insurance premium in fixed costs and again inside a per-mile figure pushes the number up for no reason. The IRS rate already covers insurance and depreciation, so a per-mile figure built from it does exactly that.
• Leaving out your own pay. An owner who drives for free has a break-even number that only holds while they keep driving for free.
• Forgetting no-shows. They cost a drive and a trip slot and usually pay nothing. Fewer of them brings you closer to break-even with the same schedule, and the guide to reducing NEMT no-shows covers what works.