Tobi Cloud

The Economics of Running an NEMT Business

If you are looking for a rewarding and profitable business opportunity in the healthcare sector, the non-emergency medical transportation (NEMT) industry is a good bet.  

The NEMT market is booming and is projected to grow exponentially in the next decade.  

According to a report on the industry outlook, the NEMT market was worth more than $9.5 billion in 2022 and is expected to reach $22 billion by 2032. That’s a compound annual growth rate (CAGR) of 9%. 

There is excellent potential for NEMT providers to tap into a lucrative and expanding market while positively impacting their clients’ lives. 

This article covers everything you need to know about the costs of running an NEMT business and the profits you can make from it. 

What does it cost to start and operate an NEMT business? 

The NEMT industry is a venture that demands a clear understanding of the financial commitments involved.  

Every cost element is critical in shaping your business’s success, from the initial setup to the day-to-day operations. 

Startup Costs 

These are the one-time expenses that you need to incur before you can launch your NEMT business.  

Vehicle Purchase and Modification Costs 

To meet the needs of different clients, you must buy one or more vehicles that suit your business’s size and type.  

Depending on your service, these vehicles could be vans, buses, or sedans. You must also make your vehicles accessible for disabled passengers by adding wheelchair lifts, ramps, special seats, safety belts, and other equipment.  

The cost of purchasing and modifying vehicles can vary considerably based on the model, condition of the vehicles, and the extent of modifications required. 

Need Help Growing Your Business?

The Tobi NEMT Growth Network unites NEMT owners nationwide, inspiring one another to realize their full potential.

Join Our Community Today!

Licensing, Permits, and Regulatory Compliance 

To run an NEMT business legally, you must get different licenses and permits depending on the state and county in which you operate, including: 

  • A business license to offer medical services. 
  • A transportation license to show that your vehicles are safe for patients. 
  • Vehicle registration to prove that your vehicles are insured and maintained. 
  • A medical certification to confirm that you have the required training and education in emergency medicine. 
  • A background check to clear you of any criminal or violent history. 

Business involves a lot of paperwork and regulations. You also must pay attention to the fees and taxes of these licenses and permits.  

When it comes to costs, it depends on where and how you run your business. Typically, you might be looking at shelling out somewhere between $30,000 and $100,000 at the start.  

Office Setup and Equipment 

A functional office space is essential for managing your NEMT business effectively. It will allow you to perform administrative tasks like scheduling, billing, accounting, and customer service.  

To set up your office, you will have to buy office furniture, computers, phones, printers, scanners, and other necessary equipment.  

You will also be covering the expenses of rent, utilities, internet, and phone services. The size, location, and amenities of your office space, as well as the number and quality of your equipment, will determine the cost of setting up and running your office. 

Operational Costs 

These are the ongoing expenses that you need to incur to keep your NEMT business running smoothly.  

Fuel and Maintenance 

Fuel and vehicle maintenance are among the most significant recurring expenses in the NEMT business.  

Be prepared for costs such as gas, oil, tires, brakes, filters, and other consumables, as well as regular servicing, repairs, and inspections.  


Insurance is a significant operational cost for NEMT businesses.  

You must insure your vehicles, business, and employees against various risks. NEMT vehicle insurance is a legal requirement to operate an NEMT business.  

In addition, liability insurance and workers’ compensation insurance are also good ways of protecting an NEMT business. 

The insurance cost depends on many factors, such as the type, size, and value of your vehicles, the number and qualifications of your drivers, the nature and scope of your service, and the level and coverage of your policy. 

Learn more about NEMT and insurance in our blog post: Do NEMT providers need insurance?  

Employee Wages and Benefits 

Your employees are the core of your service, so you need to compensate them fairly and competitively.  

This includes paying for the wages and benefits of your drivers, who transport your clients safely and comfortably, and your administrative staff, who run your business efficiently and professionally.  

The cost of employee wages and benefits depends on how many staff you have, what skills and experience they bring, and what the market and industry standards are.  

Marketing and Advertising 

To get your service noticed, you’ll need to market it and attract new clients. It’s best to start sooner rather than later.  

This means investing in marketing and advertising strategies such as building a website, creating a logo, distributing brochures and flyers, placing ads on online and local media, participating in networking and trade events, and collecting referrals and testimonials. 

Technology Investment 

To enhance your service and efficiency, you must invest in technology to help you manage and improve your operations. This includes buying NEMT software, which can help you coordinate bookings, routes, drivers, and vehicles and communicate with your clients and staff.  

It also helps track your vehicles with GPS, optimize your routes, and monitor your drivers. You may also need to buy other software and devices, such as billing and accounting software, customer relationship management software, and mobile phones and tablets.   

Variable Costs 

These expenses include taxes, unexpected repairs, or special fees for operating in a particular location. It can fluctuate depending on the volume and nature of your business.  

Toll Charges, Parking Fees, etc. 

You may have to pay these fees when you use certain roads, bridges, tunnels, or parking lots for your business trips.  

They may not seem like much, but they can affect your profits. The amount of these fees depends on where you go, how often you go, and what kind of vehicles you use. 

Unexpected Repairs and Maintenance 

Preparing for unexpected costs related to repairing or maintaining your vehicles or equipment is essential. These expenses can arise from accidents, breakdowns, or normal wear and tear.  

They might involve purchasing new parts, fixing damages, or upgrading equipment. The total cost will depend on the nature and severity of the problem and the choice of service provider for the repairs. 

How can an NEMT provider increase their income? 

You significantly improve your clients’ lives as an NEMT provider by facilitating access to quality healthcare. Yet, it’s essential to balance this noble endeavor with the sustainability and profitability of your business.  

Offer Different Payment Options 

One of the ways to boost your revenue is to offer different payment options for your clients. This means you can cater to their various needs and preferences. 

Private Pay 

This is the most straightforward way of payment.  

Many clients pay for NEMT services themselves, especially if they don’t have insurance or government coverage. This payment option allows you to set your prices and terms without interference from third parties. 


Another way to generate income is to work with insurance companies.  

This means providing NEMT services to clients with transportation benefits in their insurance plans. This payment option can give you a large, stable client base and steady and predictable income.  

However, you also must follow the insurance companies’ rules and guidelines, which may restrict your pricing and service choices. 

Government Programs 

A third option is to partner with government healthcare programs, such as Medicaid, Medicare, or Veterans Affairs.  

These programs often pay for NEMT services for eligible people, such as low-income, elderly, or disabled people.  

This payment option can be very profitable, as it guarantees a regular flow of clients who need frequent transportation to medical appointments.  

However, you also must meet the government programs’ standards and requirements, which may enforce strict quality and reporting criteria. 

Understand Your Average Fare 

Your average fare is the amount of money you charge for each trip, which affects your revenue.  

To calculate your average fare, you need to know two things: your costs and your margins. 

Your costs are the expenses you pay to run your business, such as fuel, maintenance, insurance, wages, taxes, and fees.  

Your margins are the profit you want to earn on each trip after paying your costs. For example, if your expenses are $20 per trip and you want a 25% margin, your average fare would be $25. 

Your average fare also depends on the market. Research what other NEMT providers charge and what your potential clients can afford.  

You should also consider the value and quality of your services and how they stand out from your competitors. Your goal must be to set a fair price for you and your clients. 

Increase Your Trip Volume 

One way to boost your revenue is to increase your trip volume, which means completing more trips each period. Your trip volume largely depends on how efficiently you schedule and route your trips.  

Scheduling is how you plan your appointments, and routing is how you choose and navigate your routes. 

You must use intelligent tools and techniques to optimize your scheduling and routing. 


Software applications or platforms can help you automate and streamline your scheduling and routing processes.  

For example, you can use software to track your vehicles, manage your bookings, communicate with your clients and drivers, and generate reports and invoices.  

Software can also help you optimize your routes by finding the shortest, fastest, or most cost-effective paths to your destinations. 


Data and analytics can help you improve your scheduling and routing decisions.  

For example, you can use data to identify patterns and trends in your client demand, such as peak hours, days, or seasons.  

You can also use data to monitor your performance, such as your on-time rate, customer satisfaction, and revenue per mile.  

Data can help you adjust your schedule and route to meet your client’s needs and expectations and maximize efficiency and profitability. 

Offer Ancillary Services 

Offering ancillary services can set your NEMT business apart from your competitors and attract a niche client base.  

These services often command higher fares due to the specialized equipment and trained staff required.  

However, they also entail higher costs and risks and may require additional licenses and certifications. 

Plan Strategically 

The NEMT sector is a chance to positively impact the lives of people who require urgent medical care.  

Whether you are looking to provide high-quality service, reduce expenses, or enhance your brand image, you must plan strategically and operate efficiently.  

That’s where Tobi comes in—the ultimate NEMT software solution. It helps you manage your NEMT business like a pro.  

However, buying different software separately can be costly and time-consuming. You may have to pay for multiple licenses, subscriptions, updates, integrations, training, support, etc. You may also have to deal with compatibility issues or technical glitches affecting your service quality or efficiency.   

That’s why we designed Tobi, an all-in-one, cloud-based NEMT software that provides a comprehensive management system for all aspects of NEMT operations.   

Its advanced features include automated dispatching with intelligent algorithms and routing, real-time GPS tracking for monitoring vehicle locations, and a mobile app for drivers to manage trips and navigate efficiently.  

You can also try Tobi free for 30 days and see how it can benefit your business. 

Join the thousands of satisfied NEMT providers who rely on Tobi to streamline their operations. Start your free trial today and see how Tobi can help you achieve your business goals faster.