The difference between inpatient and outpatient

In short

Inpatient vs outpatient - You're an inpatient when you're admitted to hospital and you're an outpatient when you haven't been admitted to hospital.

On this page

Inpatient vs outpatient - what's the difference?

It’s very important to know the difference between being an ‘Inpatient’ and ‘Outpatient’. 

It will show you when you’ll be covered by Medicare, Police Health, or when you’ll need to pay for something yourself. 

You're an outpatient if you're not admitted to hospital. Even if a service happens at a hospital, for example an appointment with a specialist whose office is at a hospital, you're an outpatient. 

To help, we've explained the difference between an inpatient and an outpatient in more detail below. 

What's an inpatient?

You're an inpatient when you're admitted to hospital to receive treatment or care. The most common way is when you're pre-booked for a procedure or treatment. 

A less common way is when you need to go to a hospital emergency department, and are then admitted to a hospital ward. 

Common examples of inpatient services

Some common examples of inpatient services people receive when they're admitted to hospital include (but are not limited to); 

  • Heart surgery
  • Knee replacements
  • Childbirth (vaginal or caesarean)

These are only examples, and Police Health's Gold Hospital covers 38 clinical categories. 

[Read more information about being an inpatient in our hospital guide] 

What's an outpatient?

You're an outpatient when you receive treatment or care when you're not admitted to hospital. 

Even if a service happens at a hospital, for example an appointment with a specialist whose office is at a hospital, you're an outpatient. 

Common examples of outpatient services

Examples of outpatient services include (but are not limited to); 

  • GP visits
  • Specialist consultations
  • Scans
  • Injections
  • Minor procedures in clinics 

Can you claim medical  outpatient services on private health cover?

No, private health insurers, including Police Health, can't cover outpatient services because government rules don't allow them to. 

Outpatient services are primarily funded through Medicare. However, you still may have to pay some out-of-pocket costs if the service isn't bulk billed. 

How to claim outpatient services through Medicare

Before you claim, it's important to know that Medicare won't pay a benefit if a medical service doesn't meet its rules.  

You can read more on our guide to Medicare rules here. 

If you have Medicare, the quickest way to claim your Medicare benefit is at your doctor’s office (or wherever you're being treated) straight after you pay. 

To do this, you need to be enrolled in Medicare and show your Medicare card. 

If you haven't done this, Services Australia shows you how to claim and has a list of helpful guides that covers these topics; 

  • Claim Medicare benefits at your doctor’s office
  • Claim Medicare benefits online
  • Claim Medicare benefits by mail
  • Claim a Medicare benefit for any amount over $10,000
  • Claim Medicare benefits at a service centre
  • Claim Medicare benefits for someone else
  • Track progress of your Medicare claims online
  • Adjust a paid claim
  • Statement of claim and benefit
  • Rejected claims 

Click here to read the Services Australia guide

*All benefits may be subject to Waiting Periods, Limits and other conditions. Providers must be recognised by us. Review the cover tables on the Combined, Hospital and Extras pages, and your State Premium and Benefit Guide or contact us for more information.