Am I “in” or “out”? Navigating Inpatient vs. Outpatient Care on Medicare

Even when you take good care of yourself, you may need to occasionally visit the hospital. Unlike visits to your family doctor, hospital stays can vary in cost and coverage. But did you know that your status as a patient (inpatient versus outpatient) can make a big difference in the cost of your care? Your local advisors in Medicare have answers to your questions.

What’s the Difference Between Inpatient and Outpatient Care?

According to the Centers for Medicare and Medicaid Services, inpatient and outpatient hospital stays are generally defined as the following:

  • Inpatient stays begin when you’re formally admitted to the hospital with a doctor’s order. Inpatient status ends the day before you are discharged from the hospital.
  • Outpatient stays apply to hospital visits when you’re not formally admitted to the hospital with a doctor’s order. This can include outpatient surgeries, lab tests, and x-rays. Trips to the emergency room are considered outpatient until a doctor formally admits you to the hospital.

What About Overnight Stays?

Staying overnight at the hospital doesn’t always mean you’re admitted as inpatient. To be considered inpatient, a doctor needs to formally admit you to the hospital.

In some cases, doctors provide observation services. These are hospital outpatient services that you receive while your doctor decides if you need to be admitted. We always advise that you ask the hospital staff clear and direct questions to determine if you’re considered inpatient or under observation.

How Does This Impact My Costs?

Inpatient and outpatient medical services are billed differently by Medicare. Regardless of the status of your visit, depending upon your health plan, you may pay a deductible, coinsurance, or copayment.

In general, Medicare Part A doesn’t cover outpatient services. Medicare Part B typically covers the doctor’s services and hospital outpatient services.

Depending on your specific Medicare plan, the cost will vary. If you have more questions on this, reach out to us and we can walk you through it.

A Note on Skilled Nursing Facilities

Depending on your Medicare plan, you may need to meet certain requirements to qualify for coverage in a skilled nursing facility after a hospital visit. One requirement can be a “qualifying hospital stay,” which is an inpatient hospital stay of at least three days. The “three-day stay” rule doesn’t allow outpatient services to count toward the minimum stay.

For example, depending on your coverage, say you go to the hospital and are under observation for one day. Then, you are treated as an inpatient for two days. In that case, your stay wouldn’t meet the three-day requirement.

Your Local Advisors in Medicare Are Ready to Help

If you have questions, reach out to us! As your local advisors in Medicare, we’re always eager to help get your questions answered. Contact us at 1-877-222-1942 or client@retiremediq.com.

If you’re not a RetireMEDiQ client and have questions about retirement or Medicare, please contact our team of expert advisors at 1-866-600-5638 or advice@retiremediq.com.

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