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Inpatient vs. Outpatient: What Does It Mean for Your Medicare Plan?

While being on the receiving end of healthcare, we tend to overlook the frivolity of terms like ‘inpatient’, ‘outpatient’ and ‘under observation’.

However, for those who are covered by Medicare, the terms can make all the difference in the kind of coverage that is granted to the beneficiary. For example, for those enrolled under the Original Medicare plan, the coverage rules change depending on whether you are categorized as an inpatient, outpatient or under observation.

Here are a few pointers to know your way around these terms so that you can be aware of the Medicare benefits that extend under each category.

What Does ‘Inpatient’ Mean?

An inpatient is a patient that has been admitted into the hospital, as per a doctor’s written directives. The focus here is on formal admission, as a person going to the hospital for tests or to the emergency room is not considered an inpatient.

To be called an inpatient, an individual needs to be under the care of a doctor who can grant admission rights at that particular hospital and then cares for said inpatient during their stay at the hospital. An inpatient continues to remain one until and including the day they are officially discharged from the hospital.

What Is an ‘Outpatient’?

An outpatient is a patient who is getting tests or x-rays done at the hospital under the directives of a doctor without a formal admission into a hospital room. The patient continues to remain an outpatient even if they have a surgery scheduled the same day as of the tests, are visiting the emergency room for immediate care or even if you are spending the night at the hospital getting the tests or emergency care.

Where Does Medicare Come Into This?

The type of Medicare benefits a beneficiary is entitled to for coverage differs when the labels change from inpatient to outpatient and vice versa. As an inpatient who is formally admitted into the hospital, Medicare Part A covers the cost from your allowable expenses, which cover the first 60 days of the hospital admission. Part A also covers the cost for a semi-private room, meals, medical supplies, treatments, prescriptions as well as nursing care.

On the other hand, Part B covers the costs for doctor visits during your stay at the hospital as well as an outpatient.

Is A Medicare advantage Plan Any Different for Inpatient and Outpatient Needs?

The answer is yes, it is. A Medicare advantage plan enables you to have the same coverage as both, inpatient and an outpatient. While this is subject to the copayments, deductibles and coinsurances that are part of your plan, a Medicare Advantage plan is just another way to become eligible for Medicare benefits.

Looking for more help with Medicare?

Figuring out Medicare plans alone is not easy. This is why it is always a good idea to seek the help of a licensed Medicare advisor.

Seniors for Medicare is a licensed healthcare insurance agency that provides assistance to seniors to find the best Medicare plans for their healthcare coverage.

With a series of helpful resources available on their website covering all there is to know about Medicare and its supplementary programs, as well as a team of experienced Medicare advisors in New York and New Jersey, Seniors for Medicare is one of the leading healthcare insurance providers.

Reach out to Seniors for Medicare at 800-276-1753 to get in touch with a licensed agent today.

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