this may be useful information for others.
I discovered there isn't really any good explanation of how the plans work, and even people who are very well educated and do a fair amount of research come away not really understanding the significance of that first Medicare decision.
When we sign up for Medicare, we have a once-in-a-lifetime decision to decide both (1) original v. Advantage and (2) which supplement plan & provider (if going with original).
While you can sign up for an Advantage plan every year during open enrollment, and change every year if you want, there is a single guaranteed issue period for a supplement plan. It isn't advertised that way. The general information available is that you can switch to Original Medicare at any point in time (or switch between Medicare Supplement plans at any time), and you might have a gap in coverage for pre-existing conditions for a maximum of 6 months. A friend of mine who specializes in administrative law believed this to be true.
And - while it is technically true - The reality they don't tell you is that without guaranteed issue they can (1) deny you coverage entirely or (2) charge you an arm and a leg more for coverage. These supplemental plans work the same way insurance plans did before the ACA - aside from your initial enrollment (or special enrollment period if you enroll later because you had ongoing work coverage), they don't have to cover you - and if they do, they can charge you whatever they feel your current medical condition justifies.
While Medicare Advantage plans seem cheaper (and may be for people at age 65 without pre-existing conditions at least for a while), if you later develop pre-existing conditions which cost hundreds of thousands of dollars each and every year you will be stuck paying up to $11,300 each and every year (the current in+out of network cap for Medicare plans). If you need specialized care for a rare disease, you may need to get care not only from out-of-network, but also from out-of-state providers. So even if you have a generous plan which covers all of the in-state providers your heart desires, if you have to seek a second opinion from out-of-state provider because your disease is so rare that local care is incompetetent due to lack of experience, it may not be covered at all by a Medicare Advantage plan. (Original Medicare is available wherever you go.)
At that point, it is unlikely that any Original Medicare Supplement provider will issue you a policy - OR - if they do - the policy they offer you will not be affordable.
As to choosing your supplement plan (and which insurance company will provide it) - it is, similarly, a once-in-a-lifetime choice. Supplemental insurance providers do not have to let you switch between plans (G, F, N, etc.) - AND - you can't look over at the greener pastures you discover after choosing a provider (who offered enticingly low initial rates) and switch to a different provider because, again, you have a single guaranteed issue time.
Aside from medications, my total out-of-pocket costs for the year are $3462.29 (premiums, deductible, copays, coinsurance, etc.). We chose a plan which covers all but the annual deductible - so my medical costs (aside from medication) are fixed, predictable, and low every year. (My father - who turned 90 this year - pays about $4650/year, and is on a plan which caps increases at 80 - so, relative to what I pay, the age-related difference is likely to be about 1.3 x my current rate at most.) My recollection is that my medication costs (including premiums & medication costs) were predicted to be about $500. (Under both Original and Advangate, there is generally no cap on drug costs)
If I switch to Medicare Advantage, I risk up to $11,300 each and every year (a cap that will increase over time).
The single difference that would make it worth that risk to me is if I hit the maximum number of days hospitalized. Original Medicare covers up to 90 days of hospitalization per year, and in a single period will cover an additional 60 days (once in a lifetime). The supplemental plan I'm on provides an additional 365 days of coverage. Beyond that I will be paying full price out-of-pocket. I have a friend who just passed away - for the last several years of his life he was hospitalized more than half of the time. On my plan, he would have run out of paid hospital coverage. Were I in his shoes, I would weigh the cost of Medicare Advantage Premiums (for a plan that offered unlimited hospitalization) + $11,300 in additional annual costs against the cost of the uncovered hospitalization coverage. In that instance, I would likely switch to a Medicare Advantage plan (knowing I could never return to my current plan).
The lure of $0 premium Medicare Advantage plans is incredibly strong - but most people (especially those who are currently healthy) don't understand what they are giving up when they choose a currently cheap plan and then - when health declines - get hit with unaffordable out-of-pocket expenses.
This is not where I expected to be when I started my Medicare exploration. I fully expected to enroll in a Medicare Advantage plan - a $0 premium plan is hard to turn down, let alone the bonus fitness, eyecare, and dental benefits!!
About 50 hours into my research, I realized that however attractive Medicare Advantage plans are at the outset, just like balloon mortgages with incredibly low initial interest rates, they were not good long-term options long term. There is no way to predict that I will remain healthy. And a daughter who (at age 31) has $200,000 in billed medical expenses a year + my own recently acquired rare cancer (which will likely require out-of-state care) give me an all-too-real glimpse of how costly my care might be on a Medicare Advantage plan.
I wish you the best - and hope that you aren't one of the ones who regrets the Medicare Advantage choice down the road.
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