Whenever one of our advisors at Tenzing is having a consultation, one of the first topics we discuss is which health insurance benefits you would like to have included in your policy. If you’re new to private health insurance, you may be unfamiliar with your two most common benefits; Inpatient and Outpatient.
Learn more about the key differences between these health insurance benefits.
Synonyms
- Inpatient
- Hospitalization
- Major Medical
- Catastrophic Coverage
Outpatient
- Routine Doctor Visits
- General Practitioner Visits (GP)
Requirements
| Inpatient | Outpatient |
| Treatments done in hospital | Treatments done in a clinic or hospital |
| Requires admission, usually an overnight stay | See a doctor and go home |
| Mandatory to have | Optional to add-on |
| Big ticket items, lower chance of happening | Lower priced treatments, but most frequently used benefits |
It may be easier to illustrate the differences in Inpatient vs. Outpatient when you compare the different types of treatments you can typically receive with Inpatient & Outpatient visits.
Types of Visits
| Inpatient | Outpatient |
| Surgeries | General doctor visits |
| Surgeons and Anesthetist’s fees | Specialist doctor visits |
| Room and Board | Emergency room |
| Nursing | Blood tests |
| Doctor Visits while in hospital | Biopsy, electrocardiograph, endoscopy, colonoscopy, ultrasounds, mammograms |
| Other hospitalization expenses | X-ray, MRI, PET and CET scans |
| Intensive Care | Minor surgical procedures |
| Annual health checks | |
Physiotherapy; Chiropractor; Vaccinations; Chemotherapy |
*Ultimately, whether a treatment is inpatient or outpatient will depend on whether the treatment was done while you were admitted for hospitalization or not.
What’s the difference in price?
A broad rule of thumb is to add outpatient benefits, you can expect to pay about double the cost of taking an inpatient only plan. Ultimately, this will depend on your plans benefit limits. For example, a plan that limits Outpatient to $100/visit will cost less to add outpatient than a plan where outpatient is fully covered to $6,000.
Why does it cost so much more to add Outpatient?
Outpatient visits are without a doubt your most common type of visit. While the cost for outpatient is much lower than inpatient, it’s much more likely to occur. Furthermore, when someone takes outpatient benefits, they tend to go to the doctor more than they normally would. Insurer know this & put a premium on taking outpatient.
What’s best for me?
That ultimately is up to the individual & their personal risk profile. Many of our clients don’t mind paying for outpatient visit themselves & they just want to protect against large out-of-pocket expenses.
Conversely, many people want all types of visits covered.
Speak to a Tenzing Advisor who can run you through your options & help you decide whether adding outpatient is worth it for you or not.
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