What is the Difference between Outpatient vs Inpatient? When a loved one is hospitalized, it can be difficult to understand the levels of care. Here are a few: inpatient, outpatient, and under observation. This blog post will help clear up any confusion by explaining the differences between outpatient and inpatient.
What is Inpatient Care vs Outpatient Care?
Inpatient care is when you are admitted into the hospital. This level of care is used for more serious health issues that require close monitoring. In terms of Medicare, this would apply to Part A with Medicare only.
What is Outpatient Care?
Outpatient care is when a patient visits the hospital for treatments or procedures but does not stay overnight. This kind of care are for people in stable condition. In terms of Medicare, this would apply to Part B with Medicare only.
Inpatient vs Outpatient care are very different. Understanding why things are labeled this way will help with a lot of the confusion.
What is Under Observation Care?
Under observation, your care is in inpatient setting but you are still in the hospital. The patient does not stay overnight in a room in this case. This type of care is for people that are in a stable condition and is not as serious. It usually does not do enough to warrant inpatient care but still requires close monitoring. In terms of Medicare, this would apply to Part B with Medicare only.
The main difference outpatient and inpatient is that inpatient care requires an overnight stay while outpatient care does not. The main difference between under observation care and inpatient care is that under observation care does not require an overnight stay.
When Will Skilled Nursing Facility Care Kick In?
Coverage for skilled nursing or rehabilitation services will covered by medicare. Medicare Part A will cover a portion of the cost for a limited time at a Medicare-certified skilled nursing facility (SNF).
What is Home Health Care?
If you are homebound and need intermittent skilled nursing care or therapy services, Medicare Part A and/or Part B will cover the cost of home health care.
What Are the Costs Through Medicare on Inpatient Hospital Care?
Medicare Part A covers hospital services while you are receiving inpatient care. These services include semi-private rooms (usually two or three patients per room), meals, general nursing, medications necessary for your inpatient care, and any other supplies and treatments necessary to treat your condition. For an inpatient stay, you pay your Part A deductible amount for all hospital services received during the first 60 days of your stay. Medicare part B cover Doctor’s services during your hospital stay. You pay 20% of the Medicare-approved amount for these services after paying your Part B deductible.
Medicare advantage plans cover your inpatient hospital care . Medicare Advantage plans are Medicare private insurance companies. They provide the same coverage as Medicare (excluding hospice care covered by Part A).
What Are Costs With Outpatient Care?
Part B covers outpatient care. You pay a copayment for every outpatient service received, and that amount may vary depending on the service you receive. For example, your copayment for an X-ray is likely to be different than for an emergency room visit.
Part B also covers outpatient doctor’s services. You are responsible for paying 20% of the Medicare-approved amount for these services after paying your Part B deductible.
Some screenings and preventive services are no cost to you because the Part B deductible does not apply. A Medicare Advantage plan would cover like Medicare part B.
Generally, prescription and over-the-counter drugs you receive in an outpatient setting (like an emergency department) aren’t covered by Part B. Many hospitals have policies that don’t allow patients to bring prescriptions or other drugs from home for safety reasons. If you have Medicare prescription drug coverage (Part D), these drugs may be covered by the Medicare Advantage Prescription Drug plan or stand-alone Medicare Part D Prescription Drug Plan under certain circumstances.
What Are The Costs For Observation Services Through Medicare?
While in hospital if the doctor feels you need to observed. Then that would be an outpatient stay. That means that Part A doesn’t cover your stay, and the Part B deductible applies to any services received.
Part B covers most of the same services for outpatients that it does for inpatients. You pay 20% of the Medicare-approved amount after you’ve met your Part B deductible.
Medicare advantage plans will cover most observation services similar to Medicare part B.
Part D will cover some of the drugs received while under observation status . Check with your plan to see if there are any restrictions.
In Closing, I hope this blog clears up some of the confusion with the terms for care under outpatient, inpatient and hospitalization. If you would like to look at the best ways for covering yourself in these situations, please give us a call.