Inpatient Care

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.[mfn referencenumber=1]Cigna.com, “What is Inpatient vs. Outpatient Care“, Accessed September 7, 2021[/mfn]

[keytakeaways]

• Inpatient care is medical care while admitted to a hospital or skilled healthcare facility.
• Inpatient care costs are covered by Medicare Part A after a deductible of $1484 is met.
• Once the deductible is met, Part A coverage starts and the beneficiary provides coinsurance.
• Inpatient care differs from outpatient care, which is medical care without hospitalization.

[/keytakeaways]

While under inpatient care, patients are receiving around-the-clock health care services by doctors and nurses during their hospitalization[mfn referencenumber=1]Cigna.com, “What is Inpatient vs. Outpatient Care“, Accessed September 7, 2021[/mfn]. 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 period[mfn referencenumber=2]Medicare.gov, “Medicare costs at a glance“, Accessed September 7, 2021[/mfn].

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 period, 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.[mfn referencenumber=2]Medicare.gov, “Medicare costs at a glance“, Accessed September 7, 2021[/mfn]

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 days over their lifetime and once they are used up, they must pay the full costs for inpatient care.[mfn referencenumber=2]Medicare.gov, “Medicare costs at a glance“, Accessed September 7, 2021[/mfn]

If a beneficiary has a Medicare Advantage plan, their out-of-pocket costs are plan specific. Medicare Advantage plans are required to provide the same benefits as Medicare Part A and Part B, but they are allowed to set their own deductibles and copayments.[mfn referencenumber=3]Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed September 24, 2021[/mfn]

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.[mfn referencenumber=3]Medicare.gov, “Inpatient hospital care“, Accessed September 7, 2021[/mfn]

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 removed[mfn referencenumber=4]Medicare.gov, “Outpatient hospital services“, Accessed September 7, 2021[/mfn]. Inpatient care services are covered by Medicare Part A, while Medicare Part B will cover any outpatient services they receive[mfn referencenumber=2]Medicare.gov, “Medicare costs at a glance“, Accessed September 7, 2021[/mfn].