The difference between an inpatient and outpatient is very important because it determines how and if Medicare will cover your care. You must be formally admitted by a doctor to be considered an inpatient. If you have not been formally admitted to the hospital, you are considered an outpatient.
If you stay in the hospital overnight, it does not always mean that you are a hospital inpatient. In some cases, you may stay in the hospital overnight and be considered an outpatient. Such outpatient hospital stays are called “observation stays.” Observation stays generally occur when you go to the emergency room and have symptoms that require hospital physicians to monitor you for an extended period of time.
If you are a hospital inpatient, Medicare Part A (hospital insurance) covers most of your care. If you are an outpatient, Medicare Part B (medical insurance) covers the care you receive even though you are staying in the hospital. Examples of outpatient services covered under Part B may include emergency room care and doctor’s services. Keep in mind that Part B covers doctors’ services whether you are an inpatient or outpatient.
If you have Original Medicare, the traditional Medicare program directly administered by the federal government, you may pay higher costs if Part B covers your hospital stay. If you have a Medicare Advantage plan, also known as a Medicare private health plan or Part C, you should contact your plan directly to learn what your hospital stay costs are under your plan.
Sometimes, it can be hard to tell whether the hospital considers you to be an inpatient or outpatient. However, this is very important to know since it determines the way Medicare covers your care. If you receive care at a hospital, it may be helpful for you or a family member to ask hospital staff whether you are an inpatient or outpatient. This will help you better understand the costs for your hospital stay.
Another think to keep in mind is that Medicare will only cover the care you receive at a Skilled Nursing Facility (SNF) if you were a hospital inpatient for three days and entered a Medicare-certified SNF within 30 days of leaving the hospital.
Information collected from: Medicare Rights Center
