What is the difference between Medicare Advantage and Original Medicare?
Last updated Jul 19, 2026
Reviewed by Jason Burns, Editorial Steward
Published by Senior Direct Answers · Licensed under Citation License 1.0
Original Medicare is the traditional government-run fee-for-service program (Part A hospital + Part B medical): you can see any provider that accepts Medicare, but there's no cap on annual out-of-pocket costs (many people add Medigap and a stand-alone Part D plan). Medicare Advantage (Part C) plans are private plans paid by Medicare to deliver your Part A/B benefits; they typically use provider networks and prior authorization, usually bundle drug coverage and extra benefits (dental, vision), and by law cap your annual in-network out-of-pocket spending (the cap changes yearly — it was $7,750 when the quoted testimony was given in 2022).
What the government has said, on the record
“The Medicare Advantage (MA) program allows beneficiaries enrolled in both Part A and Part B of Medicare to receive benefits from private plans rather than from the traditional fee-for-service (FFS) Medicare program. ... Plans can also provide incentives for beneficiaries to seek care from more efficient providers (e.g., in-network referrals), offer integrated Part D drug benefits and extra benefits not covered by FFS (e.g., preventive dental care), and give beneficiaries more predictable cost sharing (e.g., flat copayments for certain types of services). ... And unlike traditional Medicare, current law limits total annual out-of-pocket spending ($7,750 in 2022) for beneficiaries enrolled in MA plans”
— James E. Mathews, Ph.D., Executive Director, Medicare Payment Advisory Commission (MedPAC), Subcommittee on Oversight and Investigations, House Committee on Energy and Commerce — Medicare Advantage oversight hearing, 2022-06-28 (source)
Editor's note: MA out-of-pocket cap figure ($7,750) is the 2022 amount — update annually. MedPAC is a congressional advisory agency; Mathews served as Executive Director Nov 2017–Aug 2023.
Who said this
James E. Mathews, Ph.D. — Executive Director, Medicare Payment Advisory Commission (MedPAC) (current).
Also asked as
- What is the difference between Medicare Advantage and Original Medicare — plain answer
- Definition of the difference between Medicare Advantage and Original Medicare.
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Last verified: 2026-07-18