Ms. Iam Sick goes to the ER for fever, cough, and shortness of breath. After she’s been checked over, she’s transferred to an inpatient unit for further treatment. Once she’s settled into her hospital bed, she calls her family to tell them she’s an inpatient on floor 4 North.
But is she? There are two kinds of hospital status:
You’re an inpatient starting when you’re formally admitted to the hospital with a doctor’s order. The day before you’re discharged is your last inpatient day.
Otherwise, you’re an outpatient even if you spend one or more nights in the hospital.
Why does this matter?
Your status may affect whether Medicare will cover the cost of care you get in a skilled nursing facility (SNF) following your hospital stay. This happens often for older adults who need residential medical care after being hospitalized. For traditional Medicare (check your policy for Medicare Advantage plans), you must spend 2 midnights as an inpatient on an inpatient unit.
The decision for inpatient hospital admission is a complex medical decision based on your doctor’s judgment and your need for medically necessary hospital care. An inpatient admission is generally appropriate when you’re expected to need 2 or more midnights of medically necessary hospital care. But, your doctor must order such admission and the hospital must formally admit you in order for you to become an inpatient.
Your hospital status—whether you’re an inpatient or an outpatient—may also affect how much you pay for hospital services (like X-rays, drugs, and lab tests).
Remember, even if you stay overnight in a regular hospital bed, you might be an outpatient. Ask the doctor or hospital. To learn more, visit https://www.medicare.gov/coverage/inpatient-hospital-care/inpatient-outpatient-status