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Like Toto raising the curtain on the great and mighty Oz, three experts have revealed some of Medicare’s “dirty little secrets” — information 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 sign-up process is where and how people actually sign up.
“You don’t sign up for Medicare on the Medicare website, which would be intuitive,” she said. “You register on the Social Security website, it’s not intuitive, but that’s where you do it.”
But beyond the basics of signing up, experts said 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 telling revelations is the “commission conflict.”
Licensed agents who sell Medicare plans can earn up to three times more commissions for selling Medicare Advantage plans than for Medigap policies, meaning agents may have financial incentives to steer consumers toward plans that don’t necessarily serve their best interests.
“It’s 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 is potentially going to earn a commission year after year. … Beneficiaries have no idea.”
Jae Oh, author of “Maximize Your Medicare,” explained some of the nuances around commissions: During the first year, carriers and states allow higher commissions for selling Medicare Advantage plans. After that, or if the enrollee changes or renews their plan, the agent enjoys 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 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 are also not necessarily ideal for an individual — and they are not always offered 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, he or she may not even present it as an option to a beneficiary, experts said.
And this problem could become even more prevalent during this year’s Medicare open enrollment period. The problem has become more pronounced as insurers face pressure to increase profits and declining revenue, according to Mantell. To protect their bottom lines, many companies shift entire groups of retirees to plans that generate higher margins.
Learn more: How to add or adjust your Medicare coverage
From his perspective, Riccardi suggested two ways to avoid wrongdoing by the agent selling the Medicare plans.
The first 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 make sure the agent is legitimate.
Additionally, you can do your own homework to compare and contrast the agent’s recommendations with what Medicare’s Plan Compare tool might recommend. This requires additional work, however, because 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 come with significant hidden expenses, according to Mantell.
“People hear ‘zero monthly premium’ and think it’s free,” she said. “That’s not the price of these Medicare Advantage plans.”
While many Medicare Advantage HMO and PPO plans advertise $0 monthly premiums, Mantell said enrollees often end up paying out of pocket for almost every service they use — $20 here, $40 there, $175 for something else.
An elderly man chats with his doctor in a hospital hallway. (Getty Images) ·Luis Álvarez via Getty Images
These small copays can add up quickly, especially for seniors with chronic illnesses or significant medical needs.
“You’re under-resourced for everything you use in the health care system,” Mantell said.
The real secret, she stressed, lies in maximum spending visibility, which is rarely mentioned in these ads. For 2026, beneficiaries could pay up to $9,300 if they stay in-network — and up to $13,900 if they use both in-network and out-of-network providers.
When Mantell speaks to audiences about Medicare Advantage versus Medigap, she often asks a simple but telling question: “If you’re the one diagnosed with cancer or a chronic illness that requires expensive treatments, do you have $14,000 saved in your health care bucket?”
She said most people were stunned by this question. “They’re appalled — they say, ‘No, it’s free,'” Mantell said, adding, “It’s not free.”
While it’s not official yet, another dirty little secret is this: The standard monthly Medicare Part B premium could increase 11.5% to $206.50 in 2026. And that would be the largest one-year increase since 2016, when premiums jumped 16.1%, from $104.90 to $121.80.
“We are 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 beneficiaries, but many retirees will still feel the squeeze — especially those who also rely on Medicaid to offset their health care costs, Mantell said.
Two people and a dog on September 17, 2025, in Barcelona, Spain. (David Zorrakino/Europa Press via Getty Images) ·Europa Press News via Getty Images
His biggest concern, however, is that this isn’t a one-time spike. According to the Medicare Trustees report, Part B premiums are expected to rise 7 to 10 percent annually over the next decade, even if inflation falls to nearly 2 percent.
“If Social Security benefits go up 2 percent while Medicare premiums go up 7 or 8 percent, that’s not a viable equation for many people in this country,” Mantell said.
So how could beneficiaries plan for Part B premium increases?
“Planning on other things is definitely 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, provides 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 them in an upcoming episode of Decoding Retirement.
Every Tuesday, retirement expert and financial educator Robert Powell gives you the tools to plan your future on Decoding retirement. You can find more episodes on our video center or watch on your favorite streaming service.
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