Listen and subscribe to Decoding Retirement on Apple Podcasts, Spotifyor wherever you find your favorite podcasts.
Like Toto pulling back the curtain on the great and powerful Oz, three experts laid out some of Medicare’s “dirty little secrets”—insights every consumer should know before choosing a plan.
For starters, Marcia Mantell, author of “Creating Your Medicare Recipe,” said in a new episode of the Decoding Retirement podcast that one of the most surprising (and confusing) parts of the Medicare enrollment process is where and how people sign up.
“You don’t sign up for Medicare on the Medicare website, which would be intuitive,” he said. “You sign up on the Social Security website; it’s not intuitive, but that’s where you do it.”
But beyond the basics of registration, experts explained that there are some common mistakes to avoid, from conflicts of interest to hidden costs, that the brochures don’t mention.
Among the most revealing revelations is the “commission conflict.”
Licensed agents who sell Medicare plans can earn up to three times more in commissions for selling Medicare Advantage plans than for Medigap policies, meaning agents may have a financial incentive to steer consumers toward plans that don’t necessarily serve their best interests.
“This is one of Medicare’s biggest secrets,” said Medicare Rights Center President Fred Riccardi. “People who enroll in a Medicare Advantage plan have no idea that an individual will potentially earn commission year after year… Beneficiaries have no idea about that.”
Jae Oh, author of “Maximize Your Medicare,” explained some of the nuances around commissions: During the first year, companies and states allow higher commissions for selling Medicare Advantage plans. After that, or if the enrollee changes or renews their plan, the agent receives a lower ongoing renewal rate, Oh said.
Medicare experts have warned that insurance agents may have a conflict of interest when selling Medicare Advantage plans. (Joe Raedle/Getty Images) ·Joe Raedle via Getty Images
Medigap, however, works very differently. Each state sets its own maximum commission limits, and insurers pay agents a fixed, recurring amount within those limits. Agents have no control over these fees, which are determined by state regulations.
“Medicare Advantage plans are not necessarily bad,” Mantell said, “but they are not necessarily ideal for an individual, and they are not always presented with two equal options.”
Not only do Medicare beneficiaries “have no idea” about the financial incentive to sell a Medicare Advantage plan instead of a Medigap plan, Mantell said, they “don’t even know how to ask about it.”
In some cases, when an agent doesn’t receive a commission for a particular Medicare plan, he or she may not even present it as an option to a beneficiary, experts said.
And that problem could become even more widespread during this year’s Medicare open enrollment period. According to Mantell, the problem has become more pronounced as insurers face pressure to increase profits and decrease revenues. To protect their bottom lines, many companies are steering entire groups of retirees toward plans that generate higher margins.
Read more: How to add or adjust your Medicare coverage
From his perspective, Riccardi suggested two ways to avoid irregularities on the part of the agent selling Medicare plans.
One is to always ask for the agent’s National Producer Number (NPN), which is a unique identifier assigned by the National Association of Insurance Commissioners. You can check the producer database maintained by the National Registry of Insurance Producers to ensure the agent is legitimate.
Additionally, you can do your own legwork to compare and contrast the agent’s recommendations with what the Medicare Plan Comparison Tool might recommend. However, it requires additional work, as the tool will give you the full list of options “without any filtering system,” Oh said.
Another dirty little secret? Medicare Advantage plans, often marketed with “$0 monthly premiums,” can carry significant hidden costs, according to Mantell.
“People hear ‘zero monthly premium’ and think it’s free,” he said. “That’s not what these Medicare Advantage plans cost.”
While many Medicare Advantage HMO and PPO plans advertise $0 monthly premiums, Mantell said enrollees often end up paying out-of-pocket costs for almost every service they use: $20 here, $40 there, $175 for something else.
An elderly man talks to his doctor in a hospital hallway. (Getty Images) ·Luis Álvarez via Getty Images
These small copays can add up quickly, especially for older adults with chronic illnesses or significant medical needs.
“Everything you use in the health care system costs you nothing,” Mantell said.
The real secret, he noted, is the ultimate pocket exposure that is rarely mentioned in those ads. By 2026, beneficiaries could pay up to $9,300 if they stay in-network, and up to $13,900 if they use in-network and out-of-network providers.
When Mantell speaks to audiences about Medicare Advantage versus Medigap, he often asks a simple but revealing question: “If you are the one diagnosed with cancer or a chronic illness that requires expensive treatments, do you have $14,000 set aside in your health care account?”
He said most people are stunned by the question. “They’re horrified, they say, ‘No, it’s free,'” Mantell said, adding, “It’s not free.”
Although it’s not official yet, another dirty little secret is this: The standard monthly Medicare Part B premium could rise 11.5% to $206.50 in 2026. And that would be the largest single-year increase since 2016, when premiums rose 16.1% from $104.90 to $121.80.
“We’re really concerned about such a gigantic jump,” Mantell said. “This affordability crisis is happening before we even get to Medigap or Medicare Advantage because everyone has to pay for Part B.”
There are “extra help” programs that can help low-income recipients, but many retirees will continue to feel the squeeze, especially those who also rely on Medicaid to offset health care costs, Mantell said.
Two people and a dog, on September 17, 2025, in Barcelona, Spain. (David Zorrakino/Europa Press via Getty Images) ·News from Europa Press via Getty Images
Their deepest concern, however, is that this is not a one-time increase. According to the Medicare Trustees Report, Part B premiums are projected to rise 7% to 10% annually over the next decade, even if inflation falls back to around 2%.
“If Social Security benefits grow 2% while Medicare premiums increase 7% or 8%, that’s not a sustainable equation for many people in this country,” Mantell said.
So how could beneficiaries plan for increased Part B premiums?
“Certainly planning around other items is a good idea,” Oh said, pointing to tools like health savings accounts (HSAs) and inflation-linked investment strategies as ways to prepare for rising health care costs.
He added that the timing of Social Security benefits also plays a role. “Social Security, as a reminder, has a cost-of-living adjustment,” Oh said. “And delaying benefits, if possible, increases the monthly amount you will receive.”
Do you have questions about retirement? Email Robert Powell at yfpodcast@yahooinc.com and we’ll do our best to answer it in a future episode of Decoding Retirement.
Every Tuesday, retirement expert and financial educator Robert Powell gives you the tools to plan your future in Decoding retirement. You can find more episodes in our video center or look in your preferred streaming service.
Subscribe to the newsletter Take care of your money
Click here for the latest personal finance news to help you invest, pay off debt, buy a home, retire, and more.
Read the latest financial and business news from Yahoo Finance
