What is Inpatient vs. Outpatient Care?
The terms “inpatient” and “outpatient” have very different meanings in the health care world. Knowing the difference between inpatient vs. outpatient care can give you the edge when it comes to managing your health care, choosing a health plan, and planning ahead for out-of-pocket medical expenses related to outpatient or inpatient care.
What’s the main difference between inpatient and outpatient care?
Generally speaking, inpatient care requires you to stay in a hospital and outpatient care does not. The big difference is whether you need to be hospitalized or not.
What is inpatient care?
Inpatient care is care provided in a hospital or other type of inpatient facility, where you are admitted, and spend at least one night—sometimes more—depending on your condition.
As an inpatient:
- You are under the care of doctors, nurses, and other types of health care professionals within a hospital.
- You are often admitted to a particular service, such as Neurology, Cardiology, Orthopedics, Oncology, General Surgery, etc., depending on what you are being treated for.
- You may be an inpatient due to surgery, illness, childbirth, or traumatic injury. There are inpatient facilities and hospitals for substance use and mental health illness, as well.
- Your inpatient stay may have been planned ahead—such as a knee replacement surgery or childbirth.
- Your stay may have been the result of an emergency or unplanned illness or injury, such as a heart attack or serious car accident.
- You are in need of medicine, care, monitoring, and medical treatment—the kind that’s provided by around-the-clock medical staff.
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 even receive outpatient services, if needed.
What is outpatient care?
Outpatient care—the kind that you don’t have to stay in a hospital for—can vary greatly. 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, and even your doctor’s office.
What determines if you need inpatient vs. outpatient care?
Whether you need outpatient or inpatient care is often determined by the type of care you require. 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.
On the other hand, there are plenty of minor surgeries, procedures, medical screenings, and treatments that do not require overnight stays or hospitalization.
What are some examples of inpatient care?
Types of inpatient care include:
- Serious illness, such as flu, stroke, heart attack
- 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
What are some examples of outpatient care?
Types of outpatient care include:
- Medical screenings such as mammogram, colonoscopy, and endoscopy
- Oral surgeries and other dental procedures, such as extractions, 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?
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, including:
- Administrative costs
- Pharmacy costs
- Lab tests
- Costs for nurses, radiologists, technicians, and specialists
- Equipment and supplies that contribute to your care while you’re there
- And more
The costs for outpatient care are typically considerably less than inpatient care. You often have some control over the costs too. For example:
- Costs for diagnostic radiology and imaging can vary greatly, so
shop around for things like MRIs, PET, and CT scansto see how you can best keep your cost low.
- When it comes to needing unplanned medical care, understanding
the difference between urgent care and the ERcan ensure you don’t pay more than you need to.
- There are some outpatient screenings and procedures that are considered preventive care and covered by your plan. Things like a routine mammogram and colonoscopy are often covered 100% by your health plan.*
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Do you have coverage for inpatient vs. outpatient health care?
Your health plan covers you for medical care, in general, regardless of whether it’s outpatient or inpatient. And some outpatient care may be covered 100% as part of your preventive care. Things like a routine mammogram or routine colonoscopy are examples of outpatient preventive care.
Here’s how your plan covers you for care and services:
- You pay for care and services until you meet your plan deductible.
- Once you meet your deductible, your health plan kicks in to start sharing costs as part of coinsurance. For example, you may pay 20% of the cost for services and your plan may pay the remaining 80%.
- If you hit your out-of-pocket maximum for the year—that’s the most you’re required to pay out-of-pocket—then your health plan will start paying 100% of the costs for your care.
Understanding the difference between inpatient vs. outpatient care and services can help give you more control over your health care. It gives you more control when you’re comparing health plans, when you’re planning ahead for a medical procedure or treatment, and anticipating costs for inpatient or outpatient services.
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*Plans may vary and not all preventative care services are covered. For example, immunizations for travel are generally not covered. Refer to your plan documents for the details of your specific medical plan.
This information is for educational purposes only. It is not medical advice. Always consult your doctor for appropriate examinations, treatment, testing, and care recommendations.
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