Hiring retirees as NEMT drivers: Social Security limits, Medicare, and insurer age rules

Where retired drivers fit the schedule

NEMT work comes in fixed blocks that suit someone who wants two or three shifts a week. In-center hemodialysis is the clearest case. According to NIDDK, each patient is given a fixed time slot, most often three treatments weekly in a Monday, Wednesday, Friday rotation or a Tuesday, Thursday, Saturday rotation, and a session lasts about 4 hours. A driver who takes one of those runs three days a week keeps the same riders and still has most of the day free. The same goes for morning discharge pickups and standing therapy appointments.

Retirees bring two sets of rules that younger hires do not: the Social Security earnings limit and Medicare. Neither stops you from hiring a retiree. An owner who understands both can set shifts the driver is glad to keep. Our guide to driver shifts covers how to build those blocks; this page covers the rules around the person.

The Social Security earnings test in 2026

Social Security reduces benefits for people who work before their full retirement age and earn above an annual limit. The limit and the reduction depend on where the driver stands relative to that age.

Full retirement age is 67 for anyone born in 1960 or later. Benefits withheld under the test are not lost. Once the driver reaches full retirement age, Social Security recalculates the monthly amount to make up for the withheld months.

What counts, and the first-year rule

Social Security counts wages from a job, including bonuses, commissions, and vacation pay, and it counts wages when they are earned rather than when they are paid. Pensions, annuities, investment income, interest, veterans benefits, and other government or military retirement benefits do not count. A retired bus driver collecting a transit pension can earn up to the limit from you on top of it.

There is also a special rule for one year, usually the first year of retirement. In 2026, someone who stays below full retirement age all year counts as retired, and gets a full check, for any month with earnings of $2,040 or less. Take a 63-year-old who retires from a full-time job in October, starts benefits, and joins you in November at a few hundred dollars a month: the November and December checks still arrive, even though the year’s earnings already passed $24,480.

Example: planning hours around the limit

Say a 64-year-old driver earns $18 an hour in this example. Dividing $24,480 by $18 gives 1,360 hours, which is a little over 26 hours a week across 52 weeks. At 24 hours a week, $22,464 for the year, no benefits are withheld. At 30 hours a week, $28,080 for the year, earnings run $3,600 over the limit and Social Security withholds $1,800 of benefits. That is why it pays to agree on a weekly hour cap at hiring. Social Security asks beneficiaries to tell it when their expected earnings change, and its earnings test calculator on ssa.gov runs the numbers for a specific benefit.

Payroll is the same as for any driver

A retiree’s wages get no payroll break. IRS Publication 15 says employee wages are generally subject to Social Security and Medicare taxes regardless of the employee’s age or whether they are receiving Social Security benefits. You withhold income tax according to the driver’s W-4, withhold the driver’s 6.2% Social Security and 1.45% Medicare, and pay your matching share. Account setup and deposit dates are covered in hiring your first employee.

Medicare and your health plan

Whether your health plan or Medicare pays first for a driver 65 or older depends on your size. Under federal Medicare rules, when an employer with at least 20 employees covers a worker 65 or older through a group health plan because of current employment, the plan pays first and Medicare pays second. The same applies to the worker’s spouse who is 65 or older. You meet the 20-employee test by having 20 or more people on staff every working day of at least 20 calendar weeks, in the current year or the one before.

Two rules come with that. A plan subject to these rules has to give employees 65 and older the same benefits under the same conditions as younger employees. And an employer may not offer a Medicare beneficiary money or other benefits as an incentive to stay off the employer plan; the civil money penalty is up to $5,000 per violation, adjusted each year for inflation. A rehired retiree who works enough to qualify for coverage counts as covered because of current employment, even if the plan also covers retirees.

Below 20 employees, Medicare pays first and the group health plan pays second, unless your plan is a multi-employer plan that includes a company with 20 or more employees. Federal law does not require a business under 50 full-time and full-time-equivalent employees to offer health coverage at all; our page on driver benefits covers the 50-employee line and state rules.

Age rules when you hire

The Age Discrimination in Employment Act protects applicants and employees who are 40 or older. The EEOC enforces it against a business once 20 or more employees have worked there for at least twenty calendar weeks in the current or previous year. State laws often reach smaller companies. California’s Fair Employment and Housing Act, for example, applies to employers that regularly employ five or more people and protects anyone who has reached a 40th birthday.

Recruiting retirees on purpose is allowed. The EEOC’s rule on help wanted ads bars wording that deters older applicants, such as “young” or “recent college graduate”, but it says employers may express a preference for older workers with terms such as “over age 60,” “retirees,” or “supplement your pension.” Senior centers and retiree groups in your area are worth a post.

What you may not do is screen on age alone. Judge every applicant against the same job description, road test, and record check. If the job requires lifting or pushing wheelchairs and your company has at least 15 employees, the Americans with Disabilities Act lets you require a medical exam once you have made a conditional offer, provided you require it of everyone entering that job. Our guide to pre-employment physicals covers what that exam can include.

Insurers, brokers, and medical cards

Brokers set minimum ages, not maximums. Under MTM’s provider agreement, 21 is the youngest a driver or attendant can be. Virginia’s fee-for-service Medicaid rules put the floor at 18, plus two years as a licensed driver. The federal driver qualification rules that apply to commercial vans set a minimum of 21 and no upper limit.

Your auto insurer has more say. Carriers’ NEMT eligibility guidelines can address driver age and qualifications. One national commercial carrier’s NEMT page, for example, lists driver age among those guidelines and names younger drivers and drivers with limited experience as the ones who can affect eligibility or premiums. Underwriting differs by carrier, so send the candidate’s driving record to your agent ahead of any job offer, as you would for any driver. Our guide to getting drivers approved by your insurer explains what they review.

Where federal rules treat the van as a commercial motor vehicle, the driver needs a medical examiner’s certificate, good for 24 months at most. Some conditions shorten it; a driver with insulin-treated diabetes certified under the federal diabetes standard is re-examined every 12 months. Whether your vans fall under those rules is covered in do NEMT drivers need a CDL.

What the crash numbers say

Crash data cuts both ways, so judge the person rather than the birth year. The Insurance Institute for Highway Safety reports that, per mile driven, fatal crash rates rise noticeably starting at ages 70 to 74 and are highest for drivers 85 and older. It attributes most of that increase to older people’s greater vulnerability to injury, particularly to the chest, and to medical complications, rather than to a greater tendency to crash. At the other end, its figures put the fatal crash rate per mile for drivers 16 to 19 at just over three times the rate for drivers 20 and older.

For every driver, older or not, the practical checks are the same: a road test in the van they will drive, a ride-along with wheelchair securement, an annual driving record review, and a clear rule that drivers report any change in health or medication that affects driving.

Scheduling retired drivers in HealthRide

Retired drivers tend to want a fixed weekly schedule. In HealthRide you can save each driver’s regular shifts as a weekly pattern, so a dialysis driver who works Monday, Wednesday, and Friday lands on those days without being entered again each week. Clock-ins from the driver app feed the timecard reports, which show each driver’s clocked hours, so you and the driver can see how close the year is running to their hour cap.