My perspective was/is, if she had the surgeries 3 months apart over 2 calendar years the surgeries + PT, etc would likely exceed the Medigap premiums + OOP during that time frame . . . plus the inconvenience of long distance travel to access par providers.
The outpatient surgeries are generally manageable copays on most MAPD's ($300-$400 range per surgery). But those copays for PT can add up. Typically, if there is a MAPD plan in a rural area, one of the local hospitals will be in network. Plans don't make a habit of offering plans in an area where the local hospital isn't in network. But in that situation, I'd take a Med Supp all day every day.