How does Inpatient vs. Outpatient Status Affect Your Cost of Care?

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When you go to the hospital for services, being classified as “inpatient” or “outpatient” can significantly affect your costs for services such as x-rays, drugs and lab tests, as well as qualifying for care in a skilled nursing facility. 

You are considered an “inpatient” beginning when you are formally admitted to a hospital with a doctor’s order.  You will typically be admitted with inpatient status when your medical care is expected to require 2 or more overnight stays in the hospital. 

You are considered “outpatient” if you are getting services through the emergency room, outpatient surgery, lab tests, x-rays or other hospital services and the doctor has not written an order to admit you into the hospital as an “inpatient.”  Your hospital status can be classified as “outpatient” even if you stay overnight in the hospital.

Why Your Admittance Status Matters 

The deductibles, co-payments or coinsurance can be significantly different depending upon your admittance status as well as the type of Medicare insurance that you are enrolled in. 

If you are enrolled in a Medicare Advantage plan, the co-payments for inpatient services may be significantly different than they are for outpatient services.  

If you are enrolled in a MediGap policy where Original Medicare is considered primary coverage, depending upon your policy, costs for inpatient or outpatient services may not be tremendously different, but qualifying for skilled nursing care can be negated if you were not considered to have had inpatient status for at least 3 more days. 

How Will You Know Your Admittance Status? 

Even if you stay overnight in an inpatient hospital bed, you might still be considered as “outpatient.”  You may get a Medicare Outpatient Observation Notice or “MOON” that notifies you of your outpatient status during your visit to the hospital.  The MOON notice explains why you are classified as outpatient versus inpatient, and how your status may affect what you are paying for services from the hospital as well as for care you may receive after discharge. 

You are required to receive a MOON notice if your outpatient status lasts for more than 24 hours. 

Be Your Own Advocate 

You or your caregiver should always ask the hospital, a hospital social worker, patient advocate or your doctor if your medical care is considered inpatient or outpatient.  Keep a record of these conversations and whenever possible obtain the information in writing. 

This way, you will have fewer if any surprises when you receive your invoices for the cost of your care while in the hospital, as well as the cost for follow-up services after leaving the hospital. 

If you have any questions about how Medicare handles hospital billing or any other Medicare questions, or if you just need help enrolling, please connect with one of our Member Agents.  There are never any fees for their educational or enrollment services!

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