Listen and subscribe to Decoding Retirement on Apple Podcasts, Spotify, or wherever you find your favorite podcasts.
Like Toto pulling back the curtain on the great and powerful Oz, three experts exposed 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 on 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 actually sign up.
“You don’t sign up for Medicare on Medicare’s website, which would be intuitive,” she said. “You sign up on Social Security’s website — not intuitive, but that’s where you do it.”
But beyond the basics of enrollment, the experts explained that there are some common pitfalls to avoid, from conflicts of interest to hidden costs, that the brochures don’t tell you about.
Among the most eye-opening revelations is the “commission conflict.”
Licensed agents who sell Medicare plans may earn up to three times more in commissions for selling Medicare Advantage plans than for Medigap policies, meaning agents can have a financial incentive to steer consumers toward plans that don’t necessarily serve their best interests.
“This is one of the biggest secrets in Medicare,” Medicare Rights Center president Fred Riccardi said. “People who are enrolling in a Medicare Advantage plan have no idea that an individual is potentially going to be earning a commission year after year. … Beneficiaries have no idea about that.”
Jae Oh, author of “Maximize Your Medicare,” explained some of the nuances around commissions: In the first year, carriers and states allow higher commissions for selling Medicare Advantage plans. After that, or if the enrollee switches or renews their plan, the agent receives a lower ongoing renewal rate, Oh said.
Medicare experts have cautioned 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 flat, recurring amount within those limits. Agents have no control over these rates, which are determined by state regulations.
“Medicare Advantage plans are not necessarily bad,” Mantell said, “but they’re not necessarily ideal for an individual either — and they’re not always presented with two equal choices.”
Not only do Medicare beneficiaries “have no idea” about the financial incentive to sell a Medicare Advantage plan over a Medigap plan, Mantell said, they “don’t even know to ask about it.”
In some cases, when an agent doesn’t receive a commission on a particular Medicare plan, they may not even present it as an option to a beneficiary, the experts said.
And that problem could become even more widespread during this year’s Medicare open enrollment period. According to Mantell, the issue has become more pronounced as insurers face pressure to increase profits and declining revenues. To protect their bottom lines, many companies are steering entire groups of retirees toward plans that generate higher margins.
From his perspective, Riccardi suggested two ways to avoid wrongdoing 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 Insurance Producer Registry to make sure the agent is legitimate.
In addition, you can do your own legwork to compare and contrast the agent’s recommendations against what Medicare’s Plan Compare tool might recommend. It does take extra work, though, as the tool will provide you with the entire list of options “without any filtering system,” Oh said.
Another dirty little secret? Medicare Advantage plans, often marketed with “$0 monthly premiums,” can come with significant hidden expenses, according to Mantell.
“People hear ‘zero monthly premium’ and think it’s free,” she said. “That’s not how much 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 nearly every service they use — $20 here, $40 there, $175 for something else.
A senior man talks with his doctor in a hospital hallway. (Getty Images) ·Luis Alvarez via Getty Images
These small copays can add up quickly, especially for older adults with chronic conditions or significant medical needs.
“You’re nickel-and-dimed for everything you use in the healthcare system,” Mantell said.
The real secret, she noted, is the maximum out-of-pocket exposure that’s rarely mentioned in those ads. For 2026, beneficiaries could pay up to $9,300 if they stay in-network — and as much as $13,900 if they use both in- and out-of-network providers.
When Mantell speaks to audiences about Medicare Advantage versus Medigap, she often asks a simple but revealing question: “If you’re the one who gets a cancer diagnosis or a chronic disease that requires costly treatments, do you have $14,000 sitting aside in your healthcare bucket?”
She said most people are stunned by the question. “They’re aghast — they say, ‘No, it’s free.’” Mantell said, adding, “It’s not free.”
Though 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 climbed 16.1% from $104.90 to $121.80.
“We’re really concerned about such a gigantic jump,” Mantell said. “This affordability crisis happens before we even get to Medigap or Medicare Advantage because everyone has to pay for Part B.”
There are “extra help” programs that can assist lower-income beneficiaries, but many retirees will still feel the squeeze — especially those who also rely on Medicaid to offset healthcare costs, Mantell said.
Two people and a dog, on Sept. 17, 2025, in Barcelona, Spain. (David Zorrakino/Europa Press via Getty Images) ·Europa Press News via Getty Images
Her deeper concern, however, is that this isn’t a one-time spike. According to the Medicare Trustees Report, Part B premiums are projected to rise by 7% to 10% annually over the next decade, even if inflation drops back to near 2%.
“If Social Security benefits grow at 2% while Medicare premiums rise at 7% or 8%, that’s not a sustainable equation for many people in this country,” Mantell said.
So, how might beneficiaries plan for the increase in Part B premiums?
“Certainly planning on other elements is a good idea,” Oh said, pointing to tools like health savings accounts (HSAs) and investment strategies linked to inflation as ways to prepare for rising healthcare 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’ll receive.”
Got 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.
Each Tuesday, retirement expert and financial educator Robert Powell gives you the tools to plan for your future on Decoding Retirement. You can find more episodes on our video hub or watch on your preferred streaming service.
