Inpatient vs. Outpatient Care and Coverage
Inpatient care means you're staying in a hospital overnight. With outpatient care, you go home the same day.
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The type of care you get depends on what kind of medical care you need. Regular doctor appointments, lab work, and x-rays or MRIs are all outpatient care. If you're seriously sick or hurt, you'll probably need to be in the hospital for inpatient care.
Inpatient vs. outpatient: What is the difference?
You get inpatient care when you've been formally admitted to a hospital for at least one night, while outpatient care means you can leave and go home on the same day.
Needing inpatient care usually means you are sick or injured or need more intense care, like after a serious surgery. With outpatient care, you usually don't need to be monitored by doctors. Outpatient care includes things like regular doctor visits, tests like x-rays or MRIs, and some small surgeries.
Inpatient care usually costs more than outpatient care because it requires a higher level of medical care. For example, you might need an IV for medications or fluids, and doctors or nurses may check on you more often. With outpatient care, you usually just go to your appointment or have your procedure and go home, which means you're not taking up as many resources at the hospital.
You usually don't get to pick between inpatient and outpatient care.
The type of care you get depends on your needs and the judgement of your doctor. If you're having major surgery, for example, your doctor probably won't let you go home the same day and will admit you to the hospital for inpatient care. But for a minor surgery, you might be allowed to get outpatient care and go home the same day.
Examples of inpatient care
- Complex or major surgeries
- Serious illnesses
- Childbirth
- Serious mental health care
- Severe burns
Examples of inpatient care
- Regular doctor visits
- Tests like x-rays or MRIs
- Lab work
- Procedures like colonoscopies
- Simple or minor surgeries
Inpatient care generally refers to any medical service that requires being admitted to a hospital. It tends to be for more serious issues that require one or more overnight stays at a hospital.
If you're in the emergency room, for example, and you're asked to stay overnight for medical observation, it does not make you an inpatient. A doctor has to give the order to admit you.
More than half of all inpatient hospital admissions come through the emergency department. Health insurance plans break out emergency room versus inpatient care when it comes to your share of the costs. For example, you can't be charged more for going to an out-of-network emergency room. But if you go to an out-of-network hospital for a surgery that requires you to stay overnight, you'll be charged more and you might not even have coverage, depending on your plan.
The amount you pay for inpatient care depends on what you're in the hospital for and what your insurance pays for. You can expect to be charged between about $2,500 and $3,200 per day, and you'll likely split that cost with your insurance.
Outpatient care is medical care that doesn't require a long stay at a hospital or medical office. If you can get your procedure, test or appointment done in one day and go home, your care is likely outpatient. It also tends to be cheaper than inpatient care, because treatments are less involved and don't require you to stay overnight.
Outpatient care includes everything from normal doctor visits to simple surgeries. As long as you can leave the hospital on the same day as your appointment, the care is outpatient.
Health insurance usually breaks outpatient care into different categories. For example, you likely don't have to pay anything for annual wellness visits, but you might have a $50 copay for specialist visits. More expensive outpatient care, like imaging, procedures and surgeries, are likely to cost more.
How much does inpatient care cost?
Inpatient hospital care costs between $2,529 and $3,288 per day, on average.
You probably won't pay that much, though, if you have health insurance. If you've met your deductible, your plan will likely pick up some of the costs. Even if you have a high deductible, you'll often get a discount just for having insurance.
Daily cost of staying in a hospital
Frequently asked questions
What is the difference between inpatient and outpatient?
Inpatient care means you're staying in the hospital and outpatient care means you can go home the same day. For example, if you're in a serious car accident, you'll probably be admitted to the hospital. That's inpatient care. But if you just need to go to the hospital for an x-ray, you can get your scan and leave, which is a type of outpatient care. Inpatient care is usually more intense than outpatient care and usually costs more.
What makes you an inpatient?
Needing inpatient care means you've been admitted to the hospital overnight. You might need to stay in the hospital if you're very sick or hurt, if you've just had a baby or if you've had a major surgery. Your doctor thinks you need a higher level of medical care than you could get if you left and went home.
Is having a baby considered inpatient or outpatient?
Having a baby is usually an inpatient scenario. If you gave birth vaginally, you'll probably stay overnight. If you had a c-section, you'll likely stay for a few days. Doctors and nurses will monitor you and your baby to make sure you're well enough to go home.
Sources
Average costs for inpatient hospital care is from KFF. Other sources for this article include the Centers for Medicare & Medicaid Services (CMS), Medicare.gov and the National Library of Medicine.
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