Inpatient vs. Outpatient Care and Coverage
Inpatient care means you're getting treatment after being admitted to a hosptial, while outpatient care means you're getting treatment and going home the same day.
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The type of care you receive will depend on how involved your treatment is and the additional resources that may be required to deliver it.
What is inpatient care?
Inpatient care generally refers to any medical service that requires being admitted to a hospital. It tends to be directed toward more serious ailments and trauma that require one or more overnight stays at a hospital. Health insurance plans require you to be formally admitted to a hospital for a service to be considered inpatient.
If you're in the emergency room, for example, and you're asked to stay overnight for medical observation, it does not make you an inpatient. A doctor has to give the order to admit you.
More than half of all inpatient hospital admissions come through the emergency department. Health insurance plans break out emergency room versus inpatient facility care when it comes to your share of the costs. In some plans, the copays for emergency room services are waived if you are admitted to the hospital.
Inpatient care is broken into two parts: the facility fee and costs related to the surgeon or physician.
Generally speaking, copays for inpatient services are structured either asper stay or per day for the facility. For some of the plans surveyed, copays range from a few hundred dollars per admission up to $1,000. Depending on your policy, you may have to pay coinsurance on top of the copay.
What is outpatient care?
Outpatient care, on the other hand, is a medical service that doesn't require a prolonged stay at a facility. This type of service tends to be less expensive, because treatments are less involved and don't require you to stay in a facility. That means the hospital or medical clinic has to use fewer resources.
Outpatient care can include routine services, such as checkups, and more involved services, such as surgery. It's still an outpatient service as long as you're allowed to leave the facility the same day. Many surgical services, rehabilitation treatments and mental health services are available as outpatient care. Health insurance companies group outpatient services by type, such as primary care, specialist care and mental health care.
Your share of costs depends on the type of care you receive. Like inpatient treatment, the costs associated with the facility itself and the physician/surgeon performing the procedure are often treated as two different coverage benefits.
Inpatient vs. outpatient: What is the difference?
Outpatient vs. inpatient care is determined by whether a doctor writes an order to admit you formally to the hospital. If the doctor admits you, then the medical service will be considered inpatient.
This has a large impact on the cost of medical services, because inpatient care tends to be more expensive than outpatient. In most cases, the doctor's decision between inpatient and outpatient care comes down to how involved the treatment is.
People who are admitted as inpatients typically have more serious conditions that require prolonged monitoring and care from medical staff overnight or longer. As a result, the costs for inpatient care tend to be much higher. The patient is hypothetically using up more resources, including beds at the facility and time and service provided by other medical professionals on staff. These costs get passed along to both the insurance company and the policyholder.
Often, you won't get to pick between getting your care administered on an inpatient or outpatient basis. The type of care you receive (and, ultimately, the cost) will be based solely on how serious the hospital team thinks the medical condition or operation is. There are some exceptions, where you have more freedom in electing whether your care is conducted inside or outside of a hospital. That's primarily with rehabilitation services (covered below).
Some surgical procedures may also allow you to choose between inpatient and outpatient options. This happens more rarely, but certain types of specialized operations — on knees, for example — can be handled inpatient or outpatient. While the options may not be exactly the same, you should consider the additional costs of overnight facility stays and the time commitment.
Inpatient and outpatient rehabilitation
You may be able to choose the type of care you receive with certain services.
For example, physical therapy may be provided inpatient or outpatient. Your health insurance summary of benefits will explain the cost sharing for rehabilitation services. Many break out different copays and coinsurance when it comes to inpatient versus outpatient rehab.
Your insurance carrier can charge copays per admission/per stay or per day. If you're reviewing your health benefits, you should be aware of the difference, since it could have a big impact on your wallet.
Rehab services provided in outpatient facilities tend to have much cheaper copays, because they're akin to office visits and use fewer resources. For example, you may pay $10–$50 per visit, depending on your plan.
How much does inpatient care cost?
To give you an idea of how expensive inpatient care can be, check out this analysis of inpatient expenses per day at hospitals across the country.
Daily inpatient care cost by type of hospital
State | Gov. | Nonprofit | For-profit |
|---|---|---|---|
|
National average | $2,742 | $3,013 | $2,296 |
|
Alabama | $1,837 | $1,874 | $1,716 |
|
Alaska | $1,750 | $1,800 | $1,992 |
|
Arizona | $2,982 | $3,275 | $2,655 |
|
Arkansas | $3,388 | $1,974 | $1,878 |
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