Gas Prices Are Up. What Rising Fuel Costs Really Do to an NEMT Business

Illustrative image; not an actual Golden Age passenger, driver, or vehicle.

For a transportation business, fuel is not just one line item among many. It touches every trip.

When the price at the pump moves, your operating costs move with it. Every passenger trip, every pickup, every repositioning drive, and every return trip requires fuel. Even miles driven without a passenger can affect whether a scheduled trip supports the business financially.

That reality is especially important for non-emergency medical transportation, or NEMT. Operators must balance vehicle costs, insurance, maintenance, labor, scheduling, and customer service while providing safe and dependable transportation for people who may need ambulatory assistance or wheelchair support.

Recent fuel prices show why this deserves close attention. According to the U.S. Energy Information Administration’s Gasoline and Diesel Fuel Update, the national average price for regular gasoline was approximately $4.47 per gallon for the week of September 28, 2026. The national average for on-highway diesel was approximately $6.38 per gallon during the same week.

California was considerably higher. AAA’s California fuel-price data placed the statewide average at approximately $6.38 to $6.39 per gallon at the end of September. California gasoline had crossed the $6-per-gallon mark earlier in the month, reaching near-record territory. National gasoline prices were also about $1.35 higher than a year earlier, while diesel prices had risen sharply as well.

Fuel prices change weekly, and actual prices vary by region, vehicle, fuel type, and date. The figures above reflect the period cited, not a permanent price level.

Illustrative image; not an actual Golden Age passenger, driver, or vehicle.

The three fuel pressures NEMT operators feel first

1. Cost per paid mile

The first impact is easy to understand: the more fuel costs, the more each paid mile costs to operate.

An operator may think about a trip based on the miles a passenger rides. However, the vehicle’s fuel expense is based on all miles driven. If a passenger travels 20 miles but the vehicle drives another 10 miles to reach the pickup and another 10 miles afterward, the business is paying for 40 miles of vehicle movement.

A useful starting point is to calculate fuel cost per mile:

Fuel cost per mile = current fuel price ÷ vehicle miles per gallon

For example, a vehicle that averages 15 miles per gallon at a fuel price of $6.38 per gallon uses approximately 42.5 cents of fuel per mile. That is only a fuel calculation. It does not include driver time, maintenance, insurance, vehicle payments, cleaning, registration, or administrative work.

A wheelchair-accessible vehicle may have different fuel economy from a vehicle used primarily for ambulatory transportation. Long-distance medical trips may also create a different cost profile from short, geographically concentrated appointments. The important point is to use your own actual mileage and fuel records rather than relying on a broad industry assumption.

2. Empty or deadhead miles

Empty miles are the miles driven without a passenger. They may include:

• Driving to a pickup location

• Returning after a one-way trip

• Repositioning between appointments

• Traveling from one service area to another

• Arriving early and waiting in a location before a scheduled pickup

These miles still consume fuel, create vehicle wear, and require driver time. They may not be separately paid.

When fuel is inexpensive, inefficient routing may be easier to overlook. When fuel is above $6 per gallon in a market such as California, every unnecessary mile becomes more visible in the monthly budget.

Deadhead miles are one of the areas operators can influence. Fuel prices are largely outside a small business owner’s control. Dispatching, scheduling density, trip sequencing, and geographic planning are not.

That does not mean every trip should be accepted or declined based only on mileage. NEMT is a service business, and many passengers need dependable access to medical appointments. It does mean operators should understand how much of their total mileage is attached to passenger service and how much is being spent reaching, leaving, or repositioning around trips.

Illustrative image; not an actual Golden Age passenger, driver, or vehicle.

3. No-shows and late cancellations

A no-show can create a fuel expense before the operator knows the trip will not happen.

The driver may already be traveling to the pickup location. In some cases, the vehicle may arrive, wait, and then return without completing the trip. That can mean fuel use, driver time, and a lost opportunity to schedule another passenger.

Clear confirmation procedures can help reduce avoidable no-shows. Depending on the type of trip and the passenger’s needs, an operator may confirm:

• The pickup date and time

• The pickup location and entrance

• The destination

• Mobility equipment requirements

• Whether a caregiver or facility contact will be present

• Any timing concerns connected to an appointment

Confirmation is not a guarantee that every trip will occur. People can become ill, appointments can change, and unexpected situations happen. However, a consistent confirmation process gives the operator better information before the vehicle is dispatched.

Practical ways to manage fuel pressure

Cluster trips geographically

When possible, schedule trips that are close together in the same general area or that fit into a practical time sequence. A morning appointment in Sacramento followed by a nearby Sacramento pickup may require less repositioning than a trip that sends the vehicle back and forth between Sacramento, Roseville, and Placerville.

The same principle can apply across El Dorado, Amador, Placer, and Sacramento Counties. Trips involving Placerville, El Dorado Hills, Jackson, Ione, Sutter Creek, Roseville, Auburn, and Sacramento may require different planning because of distance, traffic, and geography.

Clustering should never compromise a passenger’s safe pickup time or medical appointment. It is a planning tool, not a reason to rush a rider.

Choose a fuel-efficient reasonable route

The shortest route is not always the best route. Traffic, road conditions, steep grades, construction, and the passenger’s needs all matter.

Review routes regularly and select the most fuel-efficient reasonable path while maintaining safe and appropriate service. A route that saves a few miles but creates unsafe access, difficult loading, or a higher risk of delay may not be the right choice.

Maintain vehicles carefully

A well-maintained vehicle may operate more efficiently and is less likely to create an avoidable service interruption. Operators should pay attention to:

• Tire pressure

• Oil and fluid changes

• Alignment

• Brake condition

• Air filters

• Preventive maintenance schedules

• Unnecessary idling

Drivers may also reduce avoidable fuel use by turning off the engine during longer waits when conditions and passenger comfort allow. Safety, climate control, and passenger needs always come first.

Match the vehicle to the trip

Fleet mix matters. A smaller vehicle may be appropriate for some ambulatory medical trips, while an accessible vehicle should be available for passengers who require wheelchair transportation.

That does not mean replacing accessible vehicles or reducing service capability. It means understanding whether each vehicle is being used for the trip types it handles most appropriately. Vehicle choice affects fuel consumption, maintenance, purchase or lease cost, and scheduling flexibility.

Track fuel per trip and per paid mile

A monthly fuel total can tell you that costs are rising, but it may not explain why.

Consider tracking:

• Total miles

• Paid passenger miles

• Empty miles

• Gallons purchased

• Fuel cost per trip

• Fuel cost per paid mile

• Fuel cost by vehicle

• No-shows and late cancellations

These figures can help an operator identify whether the primary pressure is fuel price, long repositioning distances, low scheduling density, or missed trips. That information can support more informed pricing reviews and contract discussions without relying on guesswork.

A transparent illustrative fleet example

Illustrative example only, not a projection, quote, or promise of savings.

Use your own numbers in this formula:

Fleet fuel cost = number of vehicles × monthly miles per vehicle ÷ miles per gallon × local fuel price

If the number of vehicles doubles while monthly miles per vehicle, fuel economy, and fuel price remain unchanged, the fuel portion of the budget will generally double as well. If fuel economy improves or empty miles decline, the result may change. Actual costs depend on your vehicle mix, mileage, driving conditions, local prices, passenger requirements, and scheduling.

No vendor tool or third-party estimate is being endorsed here. The most useful calculation is the one based on your own fuel receipts, odometer readings, trip records, and completed mileage.

Fuel is only one part of the operating budget

Small transportation businesses also need to plan for expenses beyond gasoline or diesel. A vehicle lease or payment may commonly fall in the range of $700 to $1,000 per month. For planning purposes, an operator may use $1,000 per vehicle per month as a conservative vehicle-cost figure, while recognizing that exact costs vary.

An insurance down payment often falls in the range of $2,000 to $2,500, although the actual amount depends on the person, operation, vehicle, coverage, driving history, and insurer. Operators should also plan for appropriate general liability, commercial auto insurance, and workers’ compensation coverage when applicable.

Maintenance, registration, cleaning, dispatching, payroll, training, taxes, and administrative work also contribute to the total cost of providing transportation.

For additional planning considerations, review Golden Age Transportation LLC’s articles on workers’ compensation and transportation operations and insurance considerations for NEMT operators.

Plan instead of reacting

Fuel prices will keep moving. The exact price next week or next month is difficult for a small operator to control.

What operators can control is the quality of their information and planning. Measure the cost of each trip. Watch empty miles. Confirm scheduled transportation. Maintain vehicles. Review the fleet mix. Revisit pricing and contract assumptions when fuel changes sharply.

Golden Age Transportation LLC provides non-emergency medical transportation for medical needs, including Ambulatory Support, Wheelchair Transportation, and Long-Distance or Inter-City Travel. Our service areas include El Dorado, Amador, Placer, and Sacramento Counties, with extended service available for qualifying long-distance medical transportation.

This article is provided for general information only and is not an endorsement of any outside company, calculator, software, or vendor. Golden Age Transportation LLC is not a disaster response service. Call 911 in an emergency.

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