6 NEMT Service Levels: Which One Do You Need?
Dream Care Rides offers six service levels from curb-to-curb to bed-to-bed. Most patients do not know which level they need — or that the choice affects both their price and their care. Booking the wrong level can mean a driver who cannot safely assist you, or paying for services you do not actually require.
This guide walks through each service level with a real patient scenario, explains the equipment and training involved, and gives you a five-question decision guide so you can book the right ride on the first call. Whether you are booking for yourself, a parent, or a patient, understanding these levels will save you time, money, and stress.
Not sure which level you need? We'll help you decide.
Level 1: Curb-to-Curb Ambulatory Transport
Patient Scenario: Maria
Maria is 62 and walks independently. She has a routine follow-up with her cardiologist but does not drive. She can walk to the curb, open the car door, sit down, and buckle her seatbelt without help. At the clinic, she walks from the drop-off point to the check-in desk on her own.
Curb-to-curb is the most basic NEMT service level. The driver picks up the patient at the curb of their home and drops them at the curb of the medical facility. The patient is responsible for getting to and from the vehicle independently. This level is appropriate for ambulatory patients who do not need physical assistance but lack their own transportation.
Pricing: Ambulatory base fare of $30–$60 plus $3.00 per mile after the first 3 miles. Curb-to-curb sits at the low end of that range. This is the most affordable NEMT option and comparable in cost to rideshare with the added benefit of a trained, scheduled driver who knows your appointment time and will wait.
Level 2: Door-to-Door Ambulatory Transport
Patient Scenario: James
James is 78 and uses a cane. He can walk, but his front porch has three steps and he needs a steadying arm to navigate them safely. At the clinic, the parking lot is long and he tires easily. He needs someone to walk beside him from his front door to the vehicle and from the vehicle to the facility entrance.
Door-to-door adds hands-on assistance at both ends of the trip. The driver walks to the patient's front door, offers a steadying arm or assistance on stairs, guides them to the vehicle, and at drop-off walks them to the facility entrance. This level is ideal for patients who can walk but are unsteady, at risk of falling, or who fatigue easily over longer distances.
Pricing: The same ambulatory range: $30–$60 base plus $3.00 per mile after the first 3 miles. Door-to-door sits a few dollars above curb-to-curb within that range. The driver spends more time at each stop, so factor in potential wait time charges for long appointments.
Level 3: Door-Through-Door Ambulatory Transport
Patient Scenario: Dorothy
Dorothy is 84 and lives alone. She walks with a walker but becomes confused in large buildings. Her dialysis center is inside a hospital complex with multiple wings and long hallways. Dorothy needs someone to walk with her from her bedroom, help her into the vehicle, and at the hospital navigate the hallways and deliver her to the dialysis treatment chair.
Door-through-door is the most comprehensive ambulatory service level. The driver enters the patient's home, assists from their starting point (living room, bedroom) to the vehicle, and at the destination navigates the facility with the patient all the way to their treatment area, waiting room, or specific department. This level addresses both physical assistance needs and navigational challenges within large medical complexes.
Pricing: Ambulatory base fare of $30–$60 plus $3.00 per mile after the first 3 miles, with door-through-door at the top of that base range. The extended time inside the home and facility may incur additional wait time charges depending on the provider. This level is especially valued by patients attending dialysis, chemotherapy, or rehabilitation appointments where the treatment area is deep inside a building. Visit our services page for a complete overview.
Level 4: Wheelchair-Accessible Transport
Patient Scenario: Robert
Robert is 71 and uses a power wheelchair following a stroke. He is being discharged from Room 412 at Advocate Christ Medical Center. He cannot transfer to a car seat and must remain in his wheelchair during transport. A nurse will wheel him to the discharge area, and the NEMT driver will take over from there — loading Robert and his chair onto the vehicle via a hydraulic lift and securing the chair for transit.
Wheelchair transport requires a specially equipped van with either a hydraulic lift or a fold-out ramp, a lowered floor for headroom, and Q'Straint four-point securement systems that lock the wheelchair to the vehicle floor. The driver is trained in proper chair positioning, lap belt and shoulder harness application, and securement verification before the vehicle moves.
This level serves patients who use manual wheelchairs, power wheelchairs, or motorized scooters and cannot safely transfer to a standard vehicle seat. It also serves patients who can technically transfer but for whom the transfer itself presents a fall or injury risk.
Pricing: $40–$70 base fare plus $3.50 per mile after the first 3 miles. The cost reflects the ADA-compliant vehicle, specialized equipment, and additional driver training required. Learn more about our wheelchair transportation in Chicago.
Level 5: Stretcher (Gurney) Transport
Patient Scenario: William
William is 68 and recovering from spinal fusion surgery. He must remain flat and cannot sit upright for the two-week post-operative period. He needs transport from the hospital to a skilled nursing facility for rehabilitation. A stretcher vehicle with a two-person crew will load him on a gurney, secure the gurney in a climate-controlled compartment, and transport him lying down for the 25-mile trip.
Stretcher transport is for patients who cannot sit upright. The vehicle carries a hospital-grade gurney with adjustable head positioning, is climate-controlled, and provides enough compartment space for medical equipment. A two-person crew handles the loading, securing, and unloading process. The driver and attendant are trained in stretcher patient handling, including safe lifting, pivot transfers, and monitoring during transport.
Pricing: $350–$400 base fare plus $6.00 per mile after the first 5 miles. Stretcher transport is the most expensive NEMT service level due to the specialized vehicle, gurney equipment, and mandatory two-person crew. Review our complete rate schedule for detailed pricing.
Level 6: Bariatric Transport
Patient Scenario: Patricia
Patricia weighs over 350 pounds and uses a bariatric wheelchair. Standard wheelchair vans have weight limits on their lifts and securement systems that may not accommodate her safely. She needs a bariatric-rated vehicle with a heavy-duty lift, reinforced securement points, and a wider entry that accommodates her bariatric chair without clearance issues.
Bariatric transport serves patients who exceed the weight capacity of standard wheelchair or stretcher vehicles, typically above 300 to 350 pounds. These vehicles feature heavy-duty hydraulic lifts rated for higher weight capacities, reinforced floors and securement points, wider door openings, and in some cases, bariatric stretchers with extended width. The driver and attendant are trained in bariatric patient handling with proper body mechanics to protect both the patient and the crew.
Pricing: Bariatric riders pay the vehicle rate plus a bariatric fee per leg: +$30 ambulatory or wheelchair, +$175 stretcher. Contact Dream Care Rides at (708) 505-6994 to confirm the right equipment for the patient's weight. We maintain bariatric-rated equipment and treat every inquiry with dignity and professionalism.
5-Question Decision Guide: Which Service Level Do You Need?
Answer these five questions in order. The first question where you answer "yes" points you to the right service level.
- Must the patient travel lying down (cannot sit upright)?
Yes: Stretcher transport — Level 5. This is the only option for patients who must remain flat during transit. - Does the patient weigh over 350 pounds or use a bariatric wheelchair?
Yes: Bariatric transport — Level 6. Standard vehicles have weight limits that may not be safe. Call for a bariatric assessment. - Does the patient use a wheelchair, power chair, or scooter and cannot transfer to a car seat?
Yes: Wheelchair transport — Level 4. The patient rides in their chair inside an ADA-compliant vehicle. - Can the patient walk but needs physical assistance inside their home or inside the medical facility?
Yes: Door-through-door ambulatory — Level 3. The driver assists from home to treatment area and back. - Can the patient walk but needs help with stairs, curbs, or getting to the vehicle?
Yes: Door-to-door ambulatory — Level 2. The driver assists from front door to vehicle and from vehicle to facility entrance.
If you answered no to all five questions, curb-to-curb ambulatory (Level 1) is likely sufficient. You may also want to consider whether a rideshare service meets your needs at a lower cost. For help understanding how to pay for your ride, read our guide to medical transportation payment options.
How Service Level Affects Your Price
The service level you book is the single biggest factor in your NEMT price. Here are Dream Care Rides' starting base rates plus mileage by service level for private pay patients (per one-way leg):
| Service Level | Base Fare | Per Mile |
|---|---|---|
| Ambulatory (Levels 1-3) | $30–$60 | $3.00/mi after the first 3 miles |
| Wheelchair (Level 4) | $40–$70 | $3.50/mi after the first 3 miles |
| Stretcher (Level 5) | $350–$400 | $6.00/mi after the first 5 miles |
| Bariatric (Level 6) | Vehicle rate + bariatric fee (+$30 ambulatory or wheelchair, +$175 stretcher) | |
The key takeaway: within the ambulatory category, curb-to-curb, door-to-door, and door-through-door all fall inside the same $30–$60 base range. You save very little by booking less assistance than you need. The price difference comes when you move from ambulatory to wheelchair or from wheelchair to stretcher — because those require different vehicles and equipment. Use our NEMT cost calculator to estimate your trip cost before booking.
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Frequently Asked Questions: NEMT Service Levels
What is the difference between curb-to-curb and door-to-door NEMT service?
Curb-to-curb service means the driver picks you up and drops you off at the curb or entrance. You are responsible for getting from your home to the vehicle and from the vehicle into the medical facility. Door-to-door service means the driver comes to your front door, assists you to the vehicle, and walks you to the entrance of the medical facility at drop-off. Door-to-door is appropriate for patients who can walk but need steadying assistance, help with steps, or someone to carry belongings.
What does door-through-door NEMT service include?
Door-through-door service goes beyond the entrance. The driver enters the home, assists the patient from their room to the vehicle, and at the destination walks the patient through the facility to the check-in desk, waiting room, or treatment area. This level is designed for patients who become disoriented in large facilities, need assistance navigating hallways, or require help checking in. It is commonly used for elderly patients with early cognitive decline or patients recovering from surgery.
When would a patient need bed-to-bed NEMT transport?
Bed-to-bed transport is for patients who cannot stand or walk independently and need assistance from the moment they leave their bed at home until they are settled in the treatment chair or hospital bed at the destination. This includes patients being discharged from hospitals to skilled nursing facilities, patients with severe mobility limitations who need help transitioning from bed to wheelchair, and patients transferring between care facilities. Bed-to-bed is the most comprehensive NEMT service level.
How do I know if I need ambulatory or wheelchair NEMT service?
You need ambulatory service if you can walk to and from the vehicle with minimal assistance, even if you use a cane or walker. You need wheelchair service if you use a wheelchair, power chair, or scooter and cannot transfer to a standard vehicle seat. Wheelchair NEMT vehicles are equipped with hydraulic lifts or ramps and Q'Straint securement systems. If you can walk short distances but tire easily, ambulatory with door-to-door assistance may be sufficient.
Does the service level affect the price of my NEMT ride?
Yes, the service level directly affects pricing. At Dream Care Rides, ambulatory transport (curb-to-curb or door-to-door) is the most affordable at $30–$60 base plus $3.00 per mile after the first 3 miles. Wheelchair transport is $40–$70 base plus $3.50 per mile after the first 3 miles because it requires a specialized vehicle, lift equipment, and additional driver time. Stretcher transport is $350–$400 base plus $6.00 per mile after the first 5 miles due to the gurney, two-person crew, and medical-grade vehicle required. Base rates are per one-way leg; a round trip is two legs.
Can I change my service level between rides?
Absolutely. Your service level should match your current medical needs, and those needs may change. A patient recovering from hip replacement surgery may need stretcher transport from the hospital, wheelchair service for follow-up appointments during early recovery, and ambulatory door-to-door service once they are walking with a cane. Call Dream Care Rides at (708) 505-6994 before each booking if your mobility situation has changed, and we will assign the appropriate vehicle and service level.
What if I book the wrong service level?
If a driver arrives and determines that a higher service level is needed for safety — for example, a patient booked ambulatory but cannot safely walk to the vehicle — the driver will contact dispatch to arrange the correct vehicle. It is always better to book one level higher than you think you need rather than one level lower. Booking too low can result in delays while a replacement vehicle is dispatched. If you are unsure, call us and describe your situation before booking.