I think part of what must be factored into the decision is what income and assets do you want and need to protect. If I got severely injured in a car wreck, fo example, and ended up in a hospital for a long stay, being on just regular Medicare would mean that I would wrack up very large bills. I wouldn't really care, though, because I own no assets and my only income is my SSDI check. That means I have nothing that anyone can sue me for. I could just default on my medical debt without incurring much of a consequence. I might not even have to do that, as most of the big hospitals in my area have programs to waive charges for people with my financial profile. There are certain advantages to being poor.

If I owned a house or had a pension independent of my SSDI, then I absolutely would not just rely on regular Medicare, as I am currently doing. I would be afraid that an extended hospital stay or major surgery could put me into serious debt that could eat up a large portion of my income and/or possibly, cost me my home, if I could not service the debt.

Geography and luck give me another lucky break. I get my health care through a hospital/clinic system that offers everything and anything. If I needed a "sleep study" done, for instance, which I am told that Medicare does not cover, they would give it to me for free. They've told me that they will eat the cost of anything that regular Medicare doesn't cover. This is because I am low income and live in the county served by this hospital/clinic system. There are advantages to living in a poor "Blue state" with a tradition of state/county provided care to the poor.

Somehow, I figure there has got to be a downside to my set-up that I may have yet to discover. So this year is an experiment for me. Getting into an Advantage plan will cost me nothing to join, but might restrict who I can go to.

In my part of the Southwest, there are no really top shelf doctors or cream of the crop hospitals. I can get everything done here, just not by the most highly rated physicians. That's the down side of being poor. If possible, you want to preserve your ability to travel to a top notch hospital and see a top notch doctor, if you develop a hard-to-treat condition. Some elective back surgeries, for instance, are best not done in the state in which I live.