By Nick Hoffmeyer, Head of Marketing at Bambi · Updated September 28, 2026 · 7 min read
Reviewed by Howard F. Berkowitz, a non-emergency medical transportation and paratransit expert with 30+ years in the industry (H&S Consulting).
Set NEMT rates by adding up your true cost per trip, driver pay, fuel, insurance, and overhead, then adding a margin on top, rather than copying a competitor's number. Most non-emergency medical transportation (NEMT) operators price too low because they base rates on what a broker offers instead of what a trip actually costs to run. A workable starting formula: (total monthly vehicle cost ÷ expected monthly trips) + target margin per trip.
What Should You Charge for an NEMT Trip?
What you charge for an NEMT trip should cover your real cost per trip plus a target margin, not just match whatever a broker's default rate schedule offers. Typical market rate ranges by vehicle type give you a sanity check, but they're a starting point, not your answer.
- Ambulatory sedan/minivan: Typical base rate: $18–$25 per trip (contracted); $45–$75 (private pay); Typical per-mile add-on: Varies by contract; Typical wait-time fee: Usually built into base
- Wheelchair van: Typical base rate: $65–$115 per trip; Typical per-mile add-on: $3–$6 per loaded mile; Typical wait-time fee: $15–$30 per half hour
- Stretcher vehicle: Typical base rate: often $120 to $300+ per trip, depending on payer; Typical per-mile add-on: varies by payer; Typical wait-time fee: Typically built into base given crew cost
These are rough ranges seen across markets, not a published standard. Rate ranges vary meaningfully by state, urban vs. rural service area, and which broker or payer is contracting the trip. Confirm current rates with your state Medicaid broker's published fee schedule before pricing a new contract. For the full cost breakdown these rates need to cover, see our NEMT revenue per vehicle deep dive.
The Cost-Plus Formula for NEMT Rate Setting
The cost-plus method is the most reliable way to set a rate you can actually sustain: calculate your fully loaded monthly cost per vehicle, divide by expected monthly trip volume, then add your target margin per trip.
Step 1: Total your monthly cost per vehicle
Add driver pay, fuel and maintenance, insurance (allocated monthly), dispatch software, and a share of overhead (admin, billing, office). These figures move by vehicle type and market; our revenue per vehicle deep dive has a full line-item table if you need a starting point, and our insurance cost review covers current premium ranges by vehicle class.
Step 2: Divide by realistic trip volume, not optimistic volume
Use your actual trailing 30- to 60-day trip count per vehicle, not the number you hope to hit. Rates built on optimistic volume assumptions are the single most common reason new NEMT operators underprice.
Step 3: Add your margin target
Most operators target 8 to 20% net margin depending on vehicle type and complexity (ambulatory tends to run lower, stretcher higher, per our vehicle-type breakdown). Add that percentage on top of your true cost per trip. Don't round down to match a competitor; round to match your own numbers.
Step 4: Stress-test against no-shows and cancellations
Build a no-show and late-cancellation buffer into your rate math. A rate that only works if every scheduled trip completes will lose money the first bad week.
Contracted Rates vs. Private-Pay Rates
Contracted rates (Medicaid broker, MCO, facility contract) and private-pay rates are two different pricing conversations, and conflating them is a common mistake.
Contracted rates are largely set by the broker or payer's fee schedule; your leverage is in the trips you refuse (rates too low for your cost structure), documented performance data, and diversifying which brokers you work with so no single one controls your revenue. For the process of landing and negotiating these contracts in the first place, see our guide to winning NEMT contracts.
Private-pay rates are entirely yours to set. This is where the cost-plus formula matters most, since there's no external fee schedule pulling you toward an unprofitable number. Private-pay work also tends to carry the best margins in a healthy payer mix, alongside Medicare Advantage and VA contracts, precisely because you control the rate.
When and How to Raise Your Rates
Raise rates when your cost per trip rises (fuel, insurance renewal, driver pay increases) faster than your revenue, or when your utilization data shows you're consistently full and turning away trips at the current rate. For contracted rates, that means bringing performance data (on-time percentage, completion rate, no-show rate) to a broker renewal conversation rather than asking for more with no evidence. For private-pay rates, a straightforward written notice with your new rate, effective 30 days out, is standard practice.
A rate increase that isn't backed by real cost data or performance proof is the hardest kind to defend, both to a broker and to yourself when it's time to renew.
FAQ
How much should I charge per NEMT trip? Enough to cover your true cost per trip (driver pay, fuel, insurance, overhead) plus a 8 to 20% margin, adjusted for vehicle type. Use published broker or Medicaid fee schedules as a sanity check, not as your starting number. Confirm current fee schedules with your state's Medicaid broker before quoting a contract rate.
Can I set my own NEMT rates, or does the broker set them? For broker and Medicaid contracts, the payer sets the fee schedule and you decide whether to accept it. For private-pay and some direct facility contracts, you set the rate. Most profitable fleets blend both, using private-pay margin to offset thinner contracted rates.
How often should NEMT rates be reviewed? Review rates at least annually, and any time a major cost input changes, an insurance renewal, a driver pay increase, or a fuel cost spike. Waiting longer risks running a contract at a loss without realizing it until year-end numbers come in.
What's the biggest rate-setting mistake new NEMT operators make? Pricing off a competitor's number or a broker's default offer instead of their own cost per trip. That usually means low-margin ambulatory work subsidizes fixed costs it was never priced to cover.
Does dispatch software actually affect what rate I need to charge? Yes, indirectly. Software that reduces deadhead miles and increases trips per vehicle lowers your true cost per trip, which means you can hit your margin target at a lower, more competitive rate. That's the mechanism behind Bambi's Run Bambi Run AI scheduling.
About the Author
Nick Hoffmeyer is Head of Marketing at Bambi, the AI-powered dispatch and scheduling platform for non-emergency medical transportation (NEMT) providers. He works with NEMT owner-operators every day on growth, SEO, and the operational systems that help fleets run more trips with less stress. More from Nick: LinkedIn
Run the numbers: the free NEMT rate calculator turns your rate card into what a trip actually bills, compared as flat, per-mile and hourly.
Price for Margin, Not Just Volume
Rates set from real cost data protect your margin even when trip volume dips. Bambi's dispatch and scheduling tools give you the trip-level data, completed trips, deadhead miles, driver hours, to know your actual cost per trip instead of guessing. See pricing or book a demo to see your numbers, not a generic estimate.
