A single non-emergency medical transportation (NEMT) vehicle typically generates $50,000 to $60,000 in gross annual revenue, with profit margins landing between 20% and 30% after expenses. That means a one-vehicle operation can expect to net roughly $10,000 to $18,000 per year in profit, while a five-vehicle fleet could gross $250,000 to $300,000 and keep $50,000 to $90,000. The range is wide because earnings depend heavily on how many trips you run per day, what payers you work with, and where you operate.
Revenue Per Vehicle
A well-scheduled NEMT vehicle can handle about 8 trips per day. At that pace, gross revenue comes in around $50,000 to $60,000 annually per vehicle before any costs are subtracted. That figure assumes consistent bookings and minimal downtime for maintenance or gaps in scheduling. In practice, new operators often run fewer trips while building relationships with healthcare facilities, Medicaid brokers, and discharge planners, so first-year revenue per vehicle tends to fall toward the lower end of that range or below it.
Revenue climbs as you add vehicles, but not perfectly linearly. Each additional vehicle adds scheduling complexity, driver management, and insurance costs. Still, scaling from one to three or four vehicles is where most owners see their income shift from a modest side business to a livable salary.
How NEMT Trips Are Priced
Most NEMT revenue comes from a base fee per trip plus a per-mile charge. Rates vary by state and payer, but Minnesota’s Medicaid rates offer a useful benchmark. For basic curb-to-curb transport (similar to a taxi-style pickup), the base rate is $12.10 per trip with a mileage rate of $1.43 per mile. For door-to-door assisted transport, which covers ambulatory patients who need help getting in and out of the vehicle, the base rate rises to $14.30 per trip with the same $1.43 per-mile charge.
A 15-mile one-way assisted trip in Minnesota, for example, would pay about $35.75. Multiply that across 8 trips a day, and daily gross revenue lands around $200 to $290 depending on trip distances. Private-pay clients and contracts with healthcare systems or insurance companies often pay higher rates than Medicaid, so operators who diversify their payer mix can push revenue higher. Wheelchair-accessible and stretcher transport commands premium rates, though the vehicles cost more upfront.
Operating Costs That Cut Into Profit
The biggest ongoing expense is labor. Job postings for NEMT drivers advertise a median hourly wage of about $32, though experienced drivers in some markets earn significantly more. If you’re hiring a full-time driver at $32 per hour for 40 hours a week, that’s roughly $66,500 per year in wages alone before payroll taxes and benefits. Owner-operators who drive their own vehicle avoid this cost entirely, which is why single-vehicle operations where the owner is also the driver tend to have the healthiest margins.
Insurance is the next major line item. Commercial auto insurance runs $4,000 to $8,000 per vehicle annually. General liability coverage adds $400 to $900 per year, and professional liability (which covers claims related to patient handling during transport) costs $500 to $1,500 per year. For a small fleet, total insurance costs in the first year often land between $10,000 and $30,000 depending on fleet size, coverage limits, and your state.
Other recurring costs include:
- Dispatch and routing software: $100 to $500 per month, typically priced per vehicle
- Fuel: varies by region and trip volume, but typically one of the top three monthly expenses
- Vehicle maintenance: brake jobs, tire replacements, and oil changes add up quickly on vehicles running 8 or more trips daily
- Vehicle payments or leasing: a wheelchair-accessible van can cost $40,000 to $80,000 new, though many operators start with used vehicles
Realistic Profit Margins
After covering all operating expenses, NEMT businesses generally keep 20% to 30% of gross revenue as profit. For a single vehicle grossing $55,000 per year with the owner driving, that translates to roughly $11,000 to $16,500 in annual profit on top of whatever the owner pays themselves as a driver wage. For an owner-operator, the real income is the combination of both: a driver’s salary plus profit from the business.
Once you’re running a fleet with hired drivers, the math changes. A three-vehicle operation grossing $165,000 might net $33,000 to $49,500, but you’re also managing payroll, compliance, scheduling, and vehicle upkeep. Operators who push margins toward the higher end tend to be disciplined about route efficiency (minimizing empty miles between pickups), maintaining high vehicle utilization rates, and negotiating favorable contracts with brokers and facilities.
What Drives Revenue Up or Down
Geography matters enormously. Rural areas have fewer competitors but longer trip distances and fewer patients, which can mean more dead miles between pickups. Urban markets offer higher trip density but fiercer competition and higher labor costs. States with robust Medicaid NEMT programs, where transportation is a covered benefit managed through brokers, provide a steadier pipeline of trips than states where the benefit is more limited.
The type of transport you offer also shapes revenue. Basic ambulatory transport has the lowest startup cost but also the lowest per-trip rates. Wheelchair-accessible vehicles cost more to purchase and insure but command higher reimbursements. Stretcher transport sits at the top of the rate scale and requires specialized vehicles and trained staff, creating a higher barrier to entry that also means less competition.
Contract mix is the other major variable. Operators who rely entirely on Medicaid broker assignments are subject to whatever rates the broker sets, and those rates can be thin. Adding private-pay clients, hospital discharge contracts, dialysis center partnerships, and insurance company agreements diversifies income and typically improves per-trip revenue. Dialysis patients are particularly valuable because they need transport three times per week on a predictable schedule, which makes route planning efficient.
The Market Is Growing
The NEMT industry was valued at $10.18 billion in 2025 and is projected to reach $10.96 billion in 2026, growing at a compound annual rate of about 7.6%. An aging population, increasing chronic disease rates, and the expansion of Medicaid transportation benefits in several states are all pushing demand higher. For new operators, this growth means the pool of potential clients is expanding, but it also means more competitors are entering the space.
Operators who invest early in wheelchair-accessible or bariatric-capable vehicles position themselves for the segments growing fastest, since the aging population increasingly needs mobility assistance beyond basic sedan transport. Building reliable relationships with healthcare facilities and maintaining on-time performance records are what separate NEMT businesses that grow from those that stall at one or two vehicles.