The Real Cost of Starting a Healthcare Transportation / NEMT Business — Even If You Think a Van and Insurance Are Enough

“The Real Cost of Starting a Healthcare Transportation / NEMT Business — Even If You Think a Van and Insurance Are Enough ~ Coach Willena McGee, RN-BSN

Introduction:

Most people think you just need a van, insurance, and a broker contract. In this article I break down why a real startup budget is closer to six figures—and how to plan for it without destroying your family’s peace or your mental health.

Imagine this for a moment.

You’ve finally decided you’re done watching everyone else “get money from Medicaid.” You’re a nurse, a therapist, or a healthcare professional who knows there is a serious need for transportation in your city. You call a few brokers, watch a few YouTube videos, and you hear the same thing:

“All you really need is a van, commercial insurance, and to sign up with a local broker. Then the trips start rolling in.”

It sounds way too easy to be true… because it is.

If that’s the message that brought you here, I’m going to be honest with you:
I’d rather be the bearer of uncomfortable truth than let you walk blindly into a decision that could damage your family’s finances and your mental health.

Why “van + insurance + broker” is not a business plan

When people tell you, “Just get a van and sign up,” what they’re really describing is the last 10% of the journey—not the first 90%.

They’re skipping:

• Business structure and legal protection

• Understanding your numbers and real startup costs

• Building systems and operations

• Marketing, relationships, and how you’ll actually get paid

• What happens if the broker changes rates, loses a contract, or stops sending you trips

A vehicle and an insurance policy do not equal a business.
They equal a payment.

What it actually costs to start a serious healthcare transportation business

If you’re planning to build a real company—not just “side money”—you need to think in terms of at least $100,000–$120,000 in startup capital.

Here’s a simplified way to look at it from a lender-ready perspective:

1. Capital reserve – ~$20,000

This is money you don’t touch for startup purchases. It exists to:

• Cover gaps when revenue is still ramping up

• Keep you from swiping personal credit cards out of panic

• Show lenders you have a cushion and aren’t living dollar-to-dollar

Too many owners skip this step and end up in survival mode within months.

2. Vehicle(s) – at least $60,000–$65,000

For a wheelchair-accessible or newer, reliable vehicle, realistic costs often land in the $60K–$65K+ range when you factor in:

• Purchase price or down payment + financing

• Taxes, tags, delivery, and any necessary conversions or equipment

Could you find something cheaper? Maybe. But if you’re building a brand that serves medically fragile clients and you want lenders to take you seriously, you can’t base your numbers on the lowest Facebook Marketplace deal you find at 1 a.m.

3. Commercial insurance – often $15,000–$20,000+ for the first year

Commercial auto insurance for NEMT/healthcare transportation is not the same as the policy you have on your personal SUV.

You need to budget for:

• Down payment / deposit to start the policy

• Monthly premiums while you’re still growing

• Higher costs if you’re new to the industry or have limited driving history in this niche

For many of my clients, I advise planning around $18,000 in that first-year insurance bucket so they’re not shocked by the quote.

4. Operations & working capital – what’s left after the big three

Whatever isn’t tied up in the vehicle, insurance, and reserves has to carry:

• Licensing and application fees

• Technology (dispatch system, CRM, phones, website, etc.)

• Fuel, maintenance, and basic repairs

• Bookkeeping, legal consults, and professional services

• Your own pay (yes, you need to eat)

This is why I often say that when you really run the math, $100,000 is the floor, not the ceiling—especially if you want to be eligible for commercial lending.

The cost most people never calculate: your peace

The numbers are one thing. The hidden cost is launching undercapitalized and:

• Waking up every day terrified a tire will blow

• Avoiding the mailbox because you’re scared of insurance notices

• Arguing with your spouse or partner because “this business was supposed to save us”

I say this with love: I’ve lived that reality.
I quit a six-figure nursing job, bought a vehicle before my business was ready, and stepped into NEMT without a clear plan. When the money dried up, so did my confidence.

That’s why in my work as WM NEMT Startup Coach, I’m so firm about:

• Knowing your numbers

• Building a plan before the purchase

• Treating your household and mental health like they matter more than a logo on a van

So… should you still do this?

Absolutely—if you’re willing to treat it like a real business.

Here’s what I recommend:

1. Map your true startup cost (including reserves).

2. Decide on your niche and service model (self-pay, mixed, etc.).

3. Walk through all 11 steps of the Build It Right From the Start™ framework so you aren’t skipping the foundation.

4. Only then move toward vehicles and insurance with strategy, not desperation.

Starting a healthcare transportation / NEMT company can absolutely be part of your legacy.
But legacy-building requires honest math. For More insight View Here