Am I In or Out? Inpatient vs. Outpatient Care

Even when you take good care of yourself, you may need to occasionally visit the hospital. Unlike visits to your family doctor or the pharmacy, hospital stays can vary greatly in cost and coverage. But did you know that your status as a patient (inpatient vs. outpatient) can make a big difference in the cost of your care?

What is the Difference Between Inpatient and Outpatient Care?

According to the official Medicare website, inpatient and outpatient hospital stays are generally defined as the following:

  • Inpatient stays begin when you are 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 in which you are not formally admitted to the hospital via 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 in the hospital overnight does not automatically mean your hospital visit is defined as an inpatient stay. A doctor still needs to formally admit you to the hospital for your stay to be considered inpatient. In some cases, doctors provide observation services. These are hospital outpatient services that you receive while your doctor decides whether you need to be admitted or not.

How Does This Impact My Costs?

Medicare includes varying levels of coverage based on the classification of your stay. Regardless of the status of your visit, you will always pay your deductible, coinsurance and/or copayment. In general, Medicare Part A does not cover outpatient services. Medicare Part B typically covers your doctor’s services and hospital outpatient services.

A Note on Skilled Nursing Facilities

Depending on what type of Medicare plan you have, you may have 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 defined as an inpatient hospital stay of at least three days. The “three-day stay” rule does not allow outpatient services to count toward the minimum stay. For example, depending on your coverage, if you go to the hospital and are under observation for one day before being treated as an inpatient for two days, your stay would not meet the requirements.

If you have questions regarding how these topics apply to your own coverage, please reach out to us at 1-877-222-1942 or client@retiremediq.com.

If you are not a RetireMEDiQ client yet and have questions about retirement or Medicare, please contact us at 1-866-600-5638 or advice@retiremediq.com to get started on your Medicare journey.

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