Expert Guide

Inpatient vs Outpatient Insurance: What's the Difference?

Understanding the difference between inpatient and outpatient medical insurance coverage is crucial for choosing the right policy. Get expert guidance from Keryl.

Understanding the Key Differences

Inpatient Care

When you're admitted to a hospital and stay overnight or longer. This includes surgeries, deliveries, ICU care, and any treatment requiring hospital admission.

Includes:

• Hospital bed and accommodation
• Surgical procedures
• Maternity and delivery
• ICU and critical care
• Emergency admissions

Outpatient Care

Medical care where you visit and go home the same day. No overnight stay required. This covers most routine medical services.

Includes:

• Doctor consultations
• Lab tests and scans
• Prescription medications
• Minor procedures
• Specialist visits

Which Cover Should You Choose?

Inpatient Only

Best for those who want protection against major medical expenses but handle routine care out of pocket.

More affordable premium

Comprehensive

Covers both inpatient and outpatient care. Best for families and those who visit doctors regularly.

Complete peace of mind

Outpatient Only

Rare option. Most insurers bundle outpatient with inpatient for better value.

Limited availability

Important Things to Know

Annual Limits Apply

Both inpatient and outpatient have separate annual limits. Make sure they're adequate for your needs.

Pre-authorization Required

Most inpatient treatments need approval from your insurer before admission.

Network Hospitals Matter

Treatment at non-network facilities may result in higher out-of-pocket costs.

Cost Differences: Inpatient vs Outpatient

Understanding the cost implications helps you choose the right coverage:

Inpatient Costs in Kenya

• Normal delivery: KES 50,000 - 200,000
• C-section: KES 150,000 - 400,000
• Appendectomy: KES 100,000 - 300,000
• ICU per day: KES 20,000 - 100,000
• Major surgery: KES 300,000 - 2,000,000+

Outpatient Costs in Kenya

• Doctor consultation: KES 1,500 - 5,000
• Specialist visit: KES 3,000 - 10,000
• Lab tests: KES 500 - 15,000
• CT/MRI scan: KES 8,000 - 25,000
• Prescription drugs: KES 500 - 10,000

*Costs vary significantly based on hospital tier (Level 1-5) and location. These are approximate ranges.

What Each Type Covers in Detail

Inpatient Coverage Includes:

Room and board (ward, semi-private, or private)

Surgical procedures and operating theater fees

Anesthesia and surgical supplies

ICU and HDU (High Dependency Unit) care

Specialist consultations during admission

Medications administered in hospital

Diagnostic tests and imaging during stay

Maternity and newborn care

Outpatient Coverage Includes:

GP and specialist consultations

Prescription medications from pharmacy

Laboratory tests and blood work

X-rays, ultrasounds, CT scans, MRIs

Minor procedures (not requiring admission)

Physiotherapy and rehabilitation sessions

Dental and optical services (if included)

Chronic disease management and monitoring

Real-Life Scenarios: Which Coverage Would Help?

Scenario 1: Flu and Fever

You wake up with high fever and body aches. You visit a clinic, see a doctor, get lab tests, and receive prescription antibiotics.

✓ Outpatient Cover needed

Scenario 2: Appendicitis

Severe abdominal pain leads to emergency room visit, diagnosis of appendicitis, and emergency surgery requiring 2-3 days hospital stay.

✓ Inpatient Cover needed

Scenario 3: Diabetes Management

Regular doctor visits every 3 months, blood sugar monitoring, HbA1c tests, and ongoing prescription medications for diabetes control.

✓ Outpatient Cover needed

Scenario 4: Childbirth

Pregnancy care includes prenatal checkups (outpatient), but delivery and 2-day hospital stay for normal delivery requires inpatient.

✓ Both Outpatient & Inpatient needed

Making the Right Choice for Your Situation

Choose Inpatient Only if:

• You're young, healthy, and rarely visit doctors
• You can afford to pay for doctor visits out of pocket
• You want protection against major medical emergencies only
• You're on a tight budget and need the most affordable option
• You have employer-provided outpatient benefits

Choose Comprehensive Cover if:

• You have children who need regular pediatric care
• You have chronic conditions requiring ongoing management
• You visit doctors frequently for various health concerns
• You want complete peace of mind and predictable costs
• You can afford slightly higher premiums for full coverage

Expert Tip: Most Kenyans benefit from comprehensive plans. Even if you're healthy now, unexpected illnesses happen. The cost difference between inpatient-only and comprehensive is often just KES 1,000-3,000 per month – worth it for complete protection and peace of mind.

💬 Ready to Get Protected?

Get personalized insurance advice and find the perfect coverage for your needs.

Keryl Insurance

Expert Guide

Inpatient vs Outpatient Insurance: What's the Difference?

Understanding the difference between inpatient and outpatient medical insurance coverage is crucial for choosing the right policy. Get expert guidance from Keryl.

Understanding the Key Differences

Inpatient Care

When you're admitted to a hospital and stay overnight or longer. This includes surgeries, deliveries, ICU care, and any treatment requiring hospital admission.

Includes:

• Hospital bed and accommodation
• Surgical procedures
• Maternity and delivery
• ICU and critical care
• Emergency admissions

Outpatient Care

Medical care where you visit and go home the same day. No overnight stay required. This covers most routine medical services.

Includes:

• Doctor consultations
• Lab tests and scans
• Prescription medications
• Minor procedures
• Specialist visits

Which Cover Should You Choose?

Inpatient Only

Best for those who want protection against major medical expenses but handle routine care out of pocket.

More affordable premium

Comprehensive

Covers both inpatient and outpatient care. Best for families and those who visit doctors regularly.

Complete peace of mind

Outpatient Only

Rare option. Most insurers bundle outpatient with inpatient for better value.

Limited availability

Important Things to Know

Annual Limits Apply

Both inpatient and outpatient have separate annual limits. Make sure they're adequate for your needs.

Pre-authorization Required

Most inpatient treatments need approval from your insurer before admission.

Network Hospitals Matter

Treatment at non-network facilities may result in higher out-of-pocket costs.

Cost Differences: Inpatient vs Outpatient

Understanding the cost implications helps you choose the right coverage:

Inpatient Costs in Kenya

• Normal delivery: KES 50,000 - 200,000
• C-section: KES 150,000 - 400,000
• Appendectomy: KES 100,000 - 300,000
• ICU per day: KES 20,000 - 100,000
• Major surgery: KES 300,000 - 2,000,000+

Outpatient Costs in Kenya

• Doctor consultation: KES 1,500 - 5,000
• Specialist visit: KES 3,000 - 10,000
• Lab tests: KES 500 - 15,000
• CT/MRI scan: KES 8,000 - 25,000
• Prescription drugs: KES 500 - 10,000

*Costs vary significantly based on hospital tier (Level 1-5) and location. These are approximate ranges.

What Each Type Covers in Detail

Inpatient Coverage Includes:

Room and board (ward, semi-private, or private)

Surgical procedures and operating theater fees

Anesthesia and surgical supplies

ICU and HDU (High Dependency Unit) care

Specialist consultations during admission

Medications administered in hospital

Diagnostic tests and imaging during stay

Maternity and newborn care

Outpatient Coverage Includes:

GP and specialist consultations

Prescription medications from pharmacy

Laboratory tests and blood work

X-rays, ultrasounds, CT scans, MRIs

Minor procedures (not requiring admission)

Physiotherapy and rehabilitation sessions

Dental and optical services (if included)

Chronic disease management and monitoring

Real-Life Scenarios: Which Coverage Would Help?

Scenario 1: Flu and Fever

You wake up with high fever and body aches. You visit a clinic, see a doctor, get lab tests, and receive prescription antibiotics.

✓ Outpatient Cover needed

Scenario 2: Appendicitis

Severe abdominal pain leads to emergency room visit, diagnosis of appendicitis, and emergency surgery requiring 2-3 days hospital stay.

✓ Inpatient Cover needed

Scenario 3: Diabetes Management

Regular doctor visits every 3 months, blood sugar monitoring, HbA1c tests, and ongoing prescription medications for diabetes control.

✓ Outpatient Cover needed

Scenario 4: Childbirth

Pregnancy care includes prenatal checkups (outpatient), but delivery and 2-day hospital stay for normal delivery requires inpatient.

✓ Both Outpatient & Inpatient needed

Making the Right Choice for Your Situation

Choose Inpatient Only if:

• You're young, healthy, and rarely visit doctors
• You can afford to pay for doctor visits out of pocket
• You want protection against major medical emergencies only
• You're on a tight budget and need the most affordable option
• You have employer-provided outpatient benefits

Choose Comprehensive Cover if:

• You have children who need regular pediatric care
• You have chronic conditions requiring ongoing management
• You visit doctors frequently for various health concerns
• You want complete peace of mind and predictable costs
• You can afford slightly higher premiums for full coverage

💬 Ready to Get Protected?

Get personalized insurance advice and find the perfect coverage for your needs.