Inpatient vs Outpatient
Health Insurance Benefits
If you have a consultation with an advisor at Tenzing Pacific Services, one of the first topics you’ll discuss is which health benefits are right for your insurance policy. If you’re new to private health insurance, you may be unfamiliar with the two most common benefits – inpatient and outpatient services.
At its simplest, outpatient coverage is for treatment that doesn’t require hospitalization; inpatient does. It’s not that easy, of course – insurance companies seem to love complexity and they have no interest in working together on a cohesive way of defining these terms. So let’s dive in:
Definition of Inpatient Health Insurance
Inpatient benefits cover significant and major accidents and illnesses, the ones that require hospitalization. Virtually all policies include this coverage – you don’t have the option to skip it. Inpatient services are expensive, even potentially financially life-changing without insurance. Relatively cheap Southeast Asia is no exception; a week’s stay in a good hospital can cost upwards of $100,000.
The various insurance companies define “inpatient” somewhat differently, but there are common themes. You generally need to be admitted and be assigned a bed with a condition that will require significant treatment. Some policies include an overnight stay in the definition, while others use a certain number of hours in hospital.
Related articles: The Ultimate Guide to Health Insurance in Vietnam 2023
Definition of Outpatient Health Insurance
As you’ve no doubt guessed, outpatient benefits consist of coverage for conditions whose treatment doesn’t require hospitalization. As discussed above, whether you are considered hospitalized depends on the definition used by your particular provider.
Most quality international health insurance policies with outpatient benefits provide coverage for these common services:
- General practitioner consult
- Specialist consult
- Prescription drugs
- Diagnostic scans and tests
- Medical equipment and supplies
Many policies also include coverage for these services, sometimes with a referral from a primary care doctor:
- Psychologist, psychiatrist
- Speech therapist
- Chinese medicine
Some policies have a separate benefit limit for health checks and vaccinations that aren’t related to any existing symptoms.
There are other caveats and exclusions specific to individual plans. Most companies provide a table of benefits that describes what’s covered, what’s not covered and any referral or other requirements. Be sure to read yours.
What’s the difference in price?
Adding outpatient benefits usually doubles the cost of an inpatient only plan. Outpatient visits happen more than hospitalization, so while the cost of each outpatient visit is undeniably lower, they occur much more frequently. Furthermore, when someone takes outpatient benefits, they tend to go to the doctor more than they normally would.
Ultimately, the cost will depend on multiple variables such as your age, the exact benefits, coverage limitations, coverage area and more. For many, an inpatient-only policy is a sensible solution: it addresses your biggest risks at a reasonable cost. You can also mitigate the need to pay out-of-pocket for relatively cheap outpatient services by finding a policy that includes some “outpatient” coverage.
Yes, some of the higher-quality plans do cover some services that don’t necessarily meet the requirements for inpatient coverage. These benefits will be clearly described in the table of benefits.
Day surgeries. Many of the high quality inpatient-only policies cover significant surgeries that don’t require hospitalization. Again, the various companies use differing definitions, but if you’re admitted to receive treatment in a surgical theater, you’re likely to be covered by one of these policies. The more significant the surgery, the more likely it will be considered either a day or inpatient surgery.
Outpatient cancer treatments. Cancer treatments are often lengthy and recurring but don’t often require hospitalization. So some policies cover testing, chemotherapy, radiation treatments and the like even if they’re done on what appears to be an outpatient basis.
Pre- and post-hospitalization benefits. Even without outpatient coverage, most policies will cover some outpatient treatment before and after a related hospitalization. For example, a prior consultation for a second opinion or tests needed to diagnose a condition, or physical therapy or removing stitches after surgery – all would be covered by this benefit.
Outpatient vs Inpatient Health Insurance Conclusion
Whether you choose only inpatient coverage or opt for a comprehensive plan will depend on your personal risk profile. Simply put, only you can decide your level of coverage, but Tenzing stands ready to help you come to an informed decision.
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These articles are intended to give you enough information to make informed decisions, but health insurance is complicated. Whether you still have questions on this topic or feel ready to take the first steps toward getting a policy, our advisors can help.
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