Your hospital status—whether you're an inpatient or an outpatient—affects how much you pay for hospital services (like X-rays, drugs, and lab tests) and may also affect whether Medicare will cover care you get in a skilled nursing facility (SNF).
- Your inpatient stay begins on the day you're formally admitted to the hospital with a doctor's order. That's your first inpatient day. The day before you're discharged is your last inpatient day (the day of discharge doesn’t count as an inpatient day.)
- You're an outpatient if you're getting emergency department services, observation services, outpatient surgery, lab tests, or X-rays, and the doctor hasn't written an order to admit you to the hospital as an inpatient. In these cases, you're an outpatient even if you stay in the hospital overnight in a regular hospital bed.
If you're in the hospital more than a few hours, you or a family member should always ask your doctor or the hospital staff if you're an inpatient or an outpatient. Make sure to ask each day during your stay. Here are some common hospital situations and a description of how Medicare will pay. Remember, you pay your deductible, coinsurance, and copayments.
|Situation||Inpatient or outpatient||Part A pays||Part B pays|
|You're in the Emergency Department (ED) (also known as the Emergency Room or "ER") and then you're formally admitted to the hospital with a doctor's order.||Inpatient||Your hospital stay||Doctor services|
|You visit the ED for a broken arm, get X-rays and a splint, and go home.||Outpatient||Nothing||Doctor services and hospital outpatient services (for example, ED visit, X-rays, splint)|
|You come to the ED with chest pain, and the hospital keeps you for 2 nights for observation services.||Outpatient||Nothing||Doctor services and hospital outpatient services (for example, ED visit, observation services, lab tests)|
|You come to the hospital for outpatient surgery, but they keep you overnight for high blood pressure. Your doctor doesn't write an order to admit you as an inpatient. You go home the next day.||Outpatient||Nothing||Doctor services and hospital outpatient services (for example, surgery, lab tests, intravenous medicines)|
|Your doctor writes an order for you to be admitted as an inpatient and the hospital later tells you they're changing your hospital status to outpatient. Your doctor must agree, and the hospital must tell you in writing—while you're still a hospital patient—that your hospital status changed.||Outpatient||Nothing||Doctor services and hospital outpatient services|