Outpatient Hospital Services

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Previously, on the blog, we talked about in-patient hospital stay vs. observation services that occur in the same hospital room. Your hospital status—whether you are an inpatient or an outpatient—affects how much you pay for hospital services (like X-rays, drugs, and lab tests). I also discussed how your hospital status may affect whether Medicare will cover care you get in a skilled nursing facility (SNF) following your hospital stay. Medicare Part B (Medical Insurance) covers medically necessary diagnostic and treatment services you get as an outpatient from a Medicare-participating hospital. These services may include:

  • Emergency or observation services, which may include an overnight stay in the hospital or outpatient clinic services, including same-day surgery

  • Laboratory tests billed by the hospital

  • Mental health care in a partial hospitalization program, if a doctor certifies that inpatient treatment would be required without it

  • X-rays and other radiology services billed by the hospital

  • Medical supplies, like splints and casts

  • Preventive and screening services

Certain drugs and biologicals that you wouldn’t usually give yourself. Generally, Part B doesn't cover prescription and over-the-counter drugs you get in an outpatient setting, sometimes called “self-administered drugs." Also, for safety reasons, many hospitals have policies that don’t allow patients to bring prescription or other drugs from home. If you have Medicare prescription drug coverage (Part D), these drugs may be covered under certain circumstances. You’ll likely need to pay out-of-pocket for these drugs and submit a claim to your drug plan for a refund. Call your drug plan for more information.

You should expect to pay 20% of the Medicare-approved amount. Whether it be the doctor or other services that a health care provider provides, you will be expected to pay more of the cost. Often the same outpatient services that are rendered in a hospital will cast more than if these same services occurred in the doctor’s office. The only good news of outpatient services taking place in a hospital is that the Part B copayment in the hospital is capped at the inpatient deductible amount. But, as though to offset this capping of your Part B copayment, you will usually pay the hospital a copayment for each Part A service you get in a hospital outpatient setting. This figure is also capped at the inpatient deductible amount.

Hillary Broome

Hillary Broome