Inpatient and outpatient care costs with Medicare
You may find yourself facing a hospital stay, but the experience can be much worse when it comes with a case of bill shock. Make sure you understand how costs vary for inpatient and outpatient hospital stays and what you can expect to pay.
Inpatient vs Outpatient: Differences
The amount you’ll pay for hospital services such as X-rays, laboratory tests, and medications varies depending on whether you receive inpatient or outpatient care.
Inpatients are people formally admitted to hospitals with orders from their doctors.
Inpatient care is typically reserved for serious health conditions or trauma. According to the Centers for Medicare & Medicaid Services, inpatients usually stay at a hospital for at least two nights under the Two-Midnight rule, but these patients may stay for weeks or months depending on their illness and ailment severity.
Outpatients aren’t admitted to hospitals with orders from their doctors.
Instead, their hospital stay is more temporary, and some may stay overnight. For example, they may visit the emergency department, but they must remain for medical observation overnight. This overnight stay still doesn’t change their patient status.
Outpatients may receive the following services during their visit:
- Emergency department services
- Observation services
- Minor surgeries
- Rehabilitation services
- Lab tests
In most cases, you will not get to choose whether you’re an inpatient or an outpatient. Medical professionals will decide for you based on the seriousness of your condition. Typically, you choose your status only if you need rehabilitation treatment. Outpatient rehab is usually much cheaper, with copays and coinsurance costing between $10 and $50 per visit. Inpatient rehabilitation costs can vary depending on the treatment and facility, but they are usually much more expensive. However, some patients appreciate the continual care inpatient treatment provides.
What Do Inpatients Pay?
When you consider inpatient vs. outpatient care, the costs for inpatient treatment get shared between patients and their health insurance providers. Inpatient care typically has two parts:
- The facility fees
- Costs related to the physician or surgeon
Inpatients pay a one-time deductible for their hospital stay. If their stay stretches beyond 60 days, they will also incur a copayment. This copayment costs $329 per day for days 61 to 90 and $658 for days 91 and every day after. Medicare Part A covers most inpatient care, including the following:
- Prescribed medications
- Use of medical supplies, appliances, and equipment
Medicare B also contributes to inpatient costs, covering most of the doctor’s services. You will typically pay a 20 percent coinsurance payment for these services.
Inpatients sometimes pay more for their medical treatment than outpatients in total because they use more hospital resources, including beds and the time of health care professionals.
Roughly, half of all inpatient admissions come via hospital emergency departments. While you’re in the emergency department, you’re treated as an outpatient. Your Part A policy will typically cover the inpatient care you receive, but not the care you receive as an outpatient.
What Do Outpatients Pay?
Medicare Part B covers 80 percent of the cost of most outpatient services after policyholders have met their yearly deductible. Outpatients are usually responsible for a small annual deductible, then the remaining 20 percent coinsurance for most or all medical services during their stay.
Outpatients typically pay a coinsurance fee for each medical service they receive after meeting the Part B deductible.
A typical outpatient may incur a separate charge for emergency room services, each X-ray required, each lab test, and observation care. Each separate coinsurance charge must cost less than the Part A deductible, which, in 2017, stands at $1,316, according to Medicare.gov. People with a Medicare Supplement Plan may not worry about this deductible, but the bill can increase for outpatients with Original Medicare and Medicare Advantage plans.
Outpatients also pay the coinsurance for all services from health professionals they receive, even those from professionals who aren’t their primary physicians.
Outpatients often pay less overall for their medical treatment than inpatients. However, this situation may not be true for outpatients requiring many expensive tests or treatments.
Too many people are unaware of how much their hospital stay will cost. Share this post with your social network and tell your family members and friends so that they’re armed with knowledge before they enter the hospital.