Inpatient Care Definition and Examples

What You Pay as an Inpatient

Doctors talking to patient in hospital ICU
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Inpatient care refers to medical treatment that is provided in a hospital or other facility and requires at least one overnight stay.

For example, hospitalists are physicians who practice only inpatient care, and no office-based or outpatient care.

Inpatient care tends to be directed towards more serious ailments and trauma that require one or more days of overnight stay at a hospital. For the purposes of healthcare coverage, health insurance plans require you to be formally admitted to a hospital for a stay for a service to be considered inpatient. This means a doctor has to write a note to give the order to admit you, so if you were in the emergency room and were asked to stay overnight for “Medical Observation”, it does not make you an inpatient.

Over half of all inpatient hospital admissions come through the emergency room department. Health insurance plans break out emergency room vs. inpatient facility care when it comes to your share of the costs. In some plans, the copays for emergency room services are waived if the patient is then admitted to the hospital.

Inpatient care is broken into two parts: the facility fee and those related to the surgeon/physician. Generally speaking, copays for inpatient services are structured either on a per stay or per day basis for the facility. For some plans, copays are often a few hundred dollars per admission and up to as much as $1,000. In a few cases, cost sharing including both a multi-hundred dollar copay and coinsurance on top of it.

Medicare: Outpatient Vs. Inpatient

If you have Medicare, you should ask whether or not you are considered inpatient or outpatient. Your hospital status (whether the hospital considers you an “inpatient” or “outpatient”) affects how much you pay for hospital services (like X-rays, drugs, and lab tests) and may also affect whether Medicare will cover care you get in a skilled nursing facility (SNF) following your hospital stay.

You’re an inpatient starting when you’re formally admitted to a 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, X-rays, or any other hospital services, and the doctor hasn’t written an order to admit you to a hospital as an inpatient. In these cases, you’re an outpatient even if you spend the night at the hospital.

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 2 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.

What You Pay as an Inpatient

What do you pay as an inpatient?

  • Medicare Part A (Hospital Insurance) covers inpatient hospital services. Generally, this means you pay a one-time deductible for all of your hospital services for the first 60 days you’re in a hospital.
  • Medicare Part B (Medical Insurance) covers most of your doctor services when you’re an inpatient. You pay 20 percent of the Medicare-approved amount for doctor services after paying the Part B deductible.
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