What is Inpatient Care?
Inpatient care is medical care provided in a hospital or other inpatient facility. Inpatients are admitted and stay at least one night depending on their condition.1Cigna.com, “What is Inpatient vs. Outpatient Care“, Accessed September 7, 2021
Key Takeaways
- Inpatient care is medical care while admitted to a hospital or skilled healthcare facility.
- Inpatient care costs are covered by Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. after a deductible of $1484 is met.
- Once the deductible is met, Part A coverage starts and the beneficiaryA person who has health care insurance through the Medicare or Medicaid programs. provides coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. .
- Inpatient care differs from outpatient careOutpatient Care is medical care that does not require an overnight stay at the hospital. Medicare Part B provides coverage for Outpatient Care., which is medical care without hospitalization.
While under inpatient care, patients are receiving around-the-clock health care services by doctors and nurses during their hospitalization1Cigna.com, “What is Inpatient vs. Outpatient Care“, Accessed September 7, 2021. When a beneficiary is enrolled in Medicare Part A, Medicare will provide coverage for their inpatient care once they max out their deductible for that period2Medicare.gov, “Medicare costs at a glance“, Accessed September 7, 2021.
What is the Average Cost for Inpatient Care?
Under Medicare Part A, costs are determined by the length of time a beneficiary receives inpatient care in a hospital. During this benefit periodA benefit period is a method used in Original Medicare to measure a beneficiaries use of hospital and skilled nursing facility (SNF) services. With each new benefit period, the beneficiary is charged a new benefit..., beneficiaries will have a deductible of $1484. When the beneficiary has fully paid their deductible, coverage will begin and they will only have to pay the coinsurance for their benefit period.2Medicare.gov, “Medicare costs at a glance“, Accessed September 7, 2021
These coinsurance payments are $0 each day for the 1st-60th days of their benefit period, and then $371 each day for the 61st-90th days. On the 91st day and onward beneficiaries will be paying $742 for each “lifetime reserve day” they use. Beneficiaries only have 60 lifetime reserve daysMedicare Part A covers up to 90 days of inpatient care per benefit period. Beneficiaries get an additional 60 days of coverage known as lifetime reserve days. Lifetime reserve days can be used once. Beneficiaries... over their lifetime and once they are used up, they must pay the full costs for inpatient care.2Medicare.gov, “Medicare costs at a glance“, Accessed September 7, 2021
If a beneficiary has a Medicare Advantage plan, their out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. are plan specific. Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). are required to provide the same benefits as Medicare Part A and Part B, but they are allowed to set their own deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. and copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service..3Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed September 24, 2021
What is the Difference Between Inpatient and Outpatient Care?
Inpatient care is patient care that requires hospitalization. This can be for a serious illness or injury that requires an emergency overnight stay or planned hospital stays such as recovering from childbirth or scheduled surgery.3Medicare.gov, “Inpatient hospital care“, Accessed September 7, 2021
Outpatient care involves medical treatments that do not require overnight stays at the hospital. These are usually things that require a doctor’s office or outpatient clinics, such as getting bloodwork done or a minor surgery like getting a mole removed4Medicare.gov, “Outpatient hospital services“, Accessed September 7, 2021. Inpatient care services are covered by Medicare Part A, while Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. will cover any outpatient services they receive2Medicare.gov, “Medicare costs at a glance“, Accessed September 7, 2021.
Citations
- 1Cigna.com, “What is Inpatient vs. Outpatient Care“, Accessed September 7, 2021
- 2Medicare.gov, “Medicare costs at a glance“, Accessed September 7, 2021
- 3Medicare.gov, “Inpatient hospital care“, Accessed September 7, 2021
- 4Medicare.gov, “Outpatient hospital services“, Accessed September 7, 2021