Inpatient vs outpatient
Inpatient services are covered private health insurance, but outpatient services usually aren’t.
We’re reader-supported and may be paid when you visit links to partner sites. We don’t compare all products in the market, but we’re working on it!
An inpatient service is any treatment you receive once you've been formally admitted to a hospital — either as a day or overnight patient. Most treatments are covered by Medicare and private health insurance. Outpatient services, on the other hand, includes anything where you're not formally admitted to hospital and isn't usually covered by your private health insurance.
What is outpatient care?
An outpatient is someone who receives medical treatment without actually being admitted to hospital. Most commonly outpatient clinics are located in public hospitals but care is sometimes provided in private hospitals, a doctor’s consulting rooms or community health centres. Outpatient services includes a range of procedures, including emergency department treatment of injuries, mental health services and X-rays. Procedures and services classed as outpatient care include:
- Emergency ward treatment without the patient being formally admitted
- Consultations with specialists to determine the most appropriate treatment for a patient
- GP visits
- Antenatal consultations with an obstetrician
- Diagnostic services such as pathology, X-rays, ultrasounds and other organ imaging
- Dispensing medication
- District and community nursing services
- Mental health and other outreach services
- Drug and alcohol services, including group sessions
What is inpatient care?
Inpatient care is when patients receive treatment during a stay in the hospital. The stay in hospital can be either overnight or just a day admission, and the patient must be formally admitted to hospital to be classed as an inpatient. This means that even if you visited an emergency room and were asked to stay overnight for observation, you still would not be classed as an inpatient. Inpatient care tends to cover a range of more serious services and procedures, such as:
- Emergency room patients who are admitted to hospital
- Intensive care
- Surgical treatment for a wide range of injuries or conditions, for example heart surgery, joint reconstructions and appendix removal
- Some cancer treatments
- In-hospital pharmaceuticals
What types of outpatient benefits are covered?
When you receive treatment as an outpatient, in most cases you will not be covered by private health insurance. You will instead need to rely on cover from Medicare, which provides benefits for things like GP visits, specialists’ consultation fees, X-rays and pathology, and eye tests performed by optometrists. Medicare covers 85% of the Medicare Benefits Schedule (MBS) fee for visits to the doctor that occur outside hospital, but if you visit a doctor who bulk-bills then you may not have to pay a cent. However, it’s worth pointing out that some other health care services you receive outside of hospital can be covered by an extras policy. These include:
- Dental exams and treatment
- Glasses and contact lenses
- Physiotherapy and chiropractic treatment
- Speech and occupational therapy
- Hearing aids
- Natural therapies, for example acupuncture or naturopathy
What types of inpatient benefits are covered?
Private health insurance hospital cover policies are designed to pay benefits on a wide range of treatments you receive as a hospital inpatient. While the exact list of procedures and services covered varies depending on the level of cover you choose, most Australian private health funds pay benefits to cover the following inpatient medical costs:
- Hospital accommodation, including for day surgery and overnight stays
- Theatre and surgical fees
- Doctors’ and specialists’ fees
- In-hospital pharmaceuticals and dressings
- Surgically implanted prostheses
- Intensive care
- Diagnostic tests
A top hospital policy will provide cover for all the inpatient procedures and services for which Medicare pays a benefit, while mid and basic hospital policies will restrict or exclude high-cost procedures. You may also get to choose the hospital where you are treated and take advantage of treatment in a private hospital, or as a private patient in a public hospital.
Compare your options and apply for cover
More guides on Finder
Property prices: You need a $100K deposit in every capital city – except this one
Saving a 20% deposit for the median priced property in most Australian cities is a six figure task.
Amazon Prime Day 2021 Australia: Early deals on now
Amazon Prime Day 2021 officially starts on June 21 - or does it? Here's a stack of early-bird deals you can get right now.
Handypay Green Loan
A Green Loan from Handypay could help you make your home more energy-efficient. Handypay green loans are available up to $75,000 on terms of up to 10 years.
Victoria floods: How much food spoilage will your home insurance cover?
There’s been over 25,000 power outages across Victoria. Home insurance can reimburse you for the food that’s gone to waste. Find out who here.
TCL 20SE Review: Great display but otherwise unremarkable
If you're after a low-cost mobile with a quality display, the TCL 20SE is appealing, but you'll otherwise be left wanting for app performance, camera quality and battery life.
Today’s ASX top stocks: Moneyme (MME ↑18.8%), Cd Private Equity Fund I (CD1 ↑18.5%)
The 10 biggest movers on the ASX for Tuesday 15 June 2021.
Amazon Prime Day: 60% off fashion deals you’re not going to want to miss
Bargain hunters - get ready to save on Nike, New Balance, Cotton On, Tommy Hilfiger, Calvin Klein and so much more.
Amazon Prime Day best home deals: Bose, iRobot and more
From home speakers to robot vacuums, these are the items to watch out for this Prime Day.
Bitcoin up 21%: Will El Salvador’s big news kick off a fresh bull run?
Bi-weekly gains of just under 9%.
You might like these...
Ask an Expert