What is Inpatient vs. Outpatient Care?

What’s the main difference between inpatient and outpatient care?

The main difference is the admission order. You are inpatient when a doctor formally provided an admission order for you to stay in a hospital, behavioral health facility, or rehabilitation center due to a need for higher level of monitoring and resources

If there is no formal admission order from a doctor for additional care, you are outpatient. This includes observation services, which are used to watch your condition and decide next steps, even if you have to stay 24 to 48 hours. 

What is inpatient care?

Inpatient care is care provided in a hospital or other type of inpatient facility. You are admitted, and spend at least one night—sometimes more—depending on your condition. 

As an inpatient, you are:

• In a hospital.
• Under the care of doctors, nurses, and other health care providers.
• In need of around-the-clock care, monitoring, or treatment.
• Often admitted to a particular service, such as Neurology, Cardiology, Orthopedics, Oncology, General Surgery, etc.

Once a doctor decides you no longer require inpatient care, you are discharged from the facility. Discharge notes often include instructions to follow up with various doctors, take prescribed medications, and receive follow-up outpatient services, if needed.

What are some examples of inpatient care?

Types of inpatient care can include:

• Surgery
• Childbirth
• Serious illness, such as the flu
• Heart attack or stroke
• Traumatic injury
• Severe burns
• Serious mental health issues
• Treatment for substance use disorder and overdoses
• Chronic diseases, such as cancer and chronic obstructive pulmonary disease (COPD), that require specialized treatment and ongoing care
• Some cosmetic procedures requiring extensive plastic surgery or reconstruction
• Gastrointestinal (GI) emergencies
• Seizures or other serious neurological disorders
• Severe dehydration or electrolyte imbalances

What is outpatient care?

Outpatient care covers a wide range of services. Other than an annual check-up or blood test, almost any other kind of care can be defined as outpatient. These may be diagnostic tests, treatments, or other types of procedures.

Outpatient care may be provided in a hospital, as well as a walk-in clinic, an outpatient surgery center, or even your doctor’s office.

What are some examples of outpatient care?

Types of outpatient care can include:

• Medical screenings such as mammogram, colonoscopy, and endoscopy
• Oral surgeries and other dental procedures, such as tooth extractions, dental implants, root canal, and gum grafts
• Minor surgeries and procedures that don’t require advanced medical care, such as laser surgery, hand or foot surgery, mole removal, and Lasik eye surgery
• Certain types of treatment used for ongoing or long-term illnesses, such as dialysis and chemotherapy

What are the costs for outpatient vs. inpatient?

Costs depend on your status (inpatient or outpatient) and where you get care.

The costs for inpatient care can add up. In addition to the cost for the treatment or surgery you’re getting, there are many other costs associated with being cared for in a hospital, such as:

• Administrative
• Pharmacy
• Lab tests
• Nurses, radiologists, technicians, and specialists that are billed separately
• Other equipment and supplies used

What costs less: inpatient or outpatient care?

The costs for outpatient care are typically less than inpatient care. You often have some control over the costs too.

For example:

• Costs for diagnostic radiology and imaging can vary, so shop around for things like MRIs, PET, and CT scans to see how you can keep your cost low.
• Often seeing providers and going to facilities that are in-network vs. out-of-network can lower costs.
• When it comes to needing unplanned medical care, understand the difference between urgent care and the ER so you don’t pay more than you need to.
• There are some outpatient screenings and procedures that are considered preventive care (like a routine mammogram or colonoscopy) and covered by your plan.¹

Learn more about how to pay less for out-of-pocket medical costs.

Examples of How Inpatient and Outpatient Costs Work

The examples below are based on a health plan that has a $1,500 deductible, 20% coinsurance after that, and $6,000 out‑of‑pocket max. 

Example 1: Outpatient test

• Allowed amount: $1,000
• If deductible is not met → you pay $1,000.
• If deductible is met → you pay 20% = $200.

Example 2: Inpatient stay

• Allowed amount: $10,000
• If deductible is not met → you pay $1,500 first.
  • Remaining: $8,500 → you pay 20% = $1,700.
  • Total you pay: $3,200, unless you hit the out‑of‑pocket maximum first.

This is just an example. Your health plan may work differently. Make sure to review your plan documents to better understand your own health care costs. 

Questions to Ask Before You Receive Care

1. Will I be admitted as an inpatient? (Will there be an inpatient admission order?)
2. Could this be billed as "observation"?
3. How long do you expect me to stay? (Hours vs. overnight or multiple nights?)
4. What type of facility is it? (Hospital outpatient department or surgical center?)
5. Which billing codes can you share for an estimate? (Ask for CPT/HCPCS.)

Understanding the difference between inpatient vs. outpatient care and services can give you more control when you’re comparing health plans, planning ahead for a medical procedure or treatment, and anticipating costs for services.

Additional Inpatient vs. Outpatient Care Frequently Asked Questions (FAQs)

What kind of care is inpatient or outpatient?

Intensive care, around-the-clock care, major surgery, and treatment for a serious illness, are examples of medical situations that would require you to be admitted to the hospital (inpatient).

On the other hand, there are plenty of minor surgeries, procedures, medical screenings, and treatments that do not require inpatient admission orders. This means the care is outpatient.

Where do you look for inpatient vs. outpatient?

You can review your:

• Discharge paperwork (look for the terms “inpatient,” “observation,” or “outpatient”).
• Explanation of Benefits (EOB) from your health plan (either paper or digital). 

Is an emergency room (ER) visit inpatient or outpatient?

It depends on what happens after the ER:

• Sent home after = outpatient
• Kept for observation = outpatient (even if it's overnight)
• Admitted = inpatient (when doctor writes an admission order)