The Difference between Inpatient and Outpatient

The difference between inpatient and outpatient hospital status affects how much you pay for hospital services.

  • You’re an inpatient starting when you’re formally admitted to the hospital with a doctor’s order. The day before you’re discharged is your last inpatient day.
  • You’re an outpatient if you’re getting emergency department services, observation services, outpatient surgery, lab tests, or X-rays, or any other hospital services, and the doctor hasn’t written an order to admit you to a hospital as an inpatient.

The decision for inpatient hospital admission is a complex medical decision based on your doctor’s judgment and your need for medically necessary hospital care. An inpatient admission is generally appropriate when you’re expected to need two or more midnights of medically necessary hospital care, but your doctor must order such admission and the hospital must formally admit you in order for you to become an inpatient.

The difference between inpatient and outpatient – Part A and Part B

If you are a hospital inpatient, Medicare Part A (hospital insurance) covers most of your care. Part A covers a semiprivate room, meals, care provided to you by nurses, x-rays, supplies, equipment and medications.

If you are an outpatient, then Medicare Part B (medical insurance) covers the care you receive. Examples of outpatient services covered under Part B may include emergency room care and doctors’ services. Keep in mind that Part B covers doctors’ services whether you are an inpatient or outpatient.

The above is true, if you have Original Medicare. If you have a Medicare Advantage plan, you should contact your plan directly to learn what your hospital stay costs are under your plan.

The difference between inpatient and outpatient – Examples

If you’re in the Emergency Room or “ER” and then you’re formally admitted to the hospital with a doctor’s order, then you are outpatient until you’re formally admitted as an inpatient based on your doctor’s order. Part A pays for your inpatient hospital stay, Part B – for your doctor services.

You visit the ER and are sent to the intensive care unit (ICU) for close monitoring. Your doctor expects you to be sent home the next morning unless your condition worsens. Your condition resolves and you’re sent home the next day. Your status is outpatient. Part A pays nothing, Part B pays for your doctor services.

You go to a hospital for outpatient surgery, but they keep you overnight for high blood pressure. Your doctor doesn’t write an order to admit you as an inpatient. You go home the next day. Your status is outpatient. Part A pays nothing, Part B pays for doctor services and hospital outpatient services (for example, surgery, lab tests, or intravenous medicines).

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