January is always a critical month for Medicare beneficiaries, but January 2026 stands out as one of the most important transition points in modern Medicare history. With the first-ever Medicare‑negotiated drug prices taking effect, a new Part D out‑of‑pocket cap, Medicare Advantage rule changes, and updated Social Security benefits, South Carolina residents will feel these changes immediately.

 

Whether you’re reviewing your coverage in Greenville, Columbia, Charleston, or any of South Carolina’s growing communities, this guide breaks down everything you need to know — clearly, simply, and with your financial protection in mind.

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Table of Contents

1. Introduction: Why January 2026 Matters
2. The New $2,100 Part D Out‑of‑Pocket Cap
3. First‑Ever Medicare‑Negotiated Drug Prices
4. Medicare Advantage Changes for 2026
5. Part B & Part A Cost Changes
6. Social Security COLA for 2026
7. Medicaid & Dual‑Eligible Updates
8. What South Carolina Beneficiaries Should Do in January
9. References
10. FAQ
11. Contact Mauldin Insurance Group

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1. Introduction: Why January 2026 Matters

Every January, Medicare beneficiaries begin living under a new set of rules — new premiums, new deductibles, new drug costs, and new plan structures. Even if you didn’t change your plan during the Annual Enrollment Period, your plan changed on you.

For South Carolina’s 1.2 million Medicare beneficiaries, these changes affect:

• Prescription drug costs
• Doctor networks
• Hospital coverage
• Medicare Advantage benefits
• Monthly Social Security income
• Out‑of‑pocket spending

If you’re Turning 65 in South Carolina, these updates shape your very first year on Medicare. If you’re already enrolled, they determine how your coverage performs in 2026.

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2. The New $2,100 Part D Out‑of‑Pocket Cap (2026)

One of the most significant Medicare changes in decades is now active:
Medicare Part D out‑of‑pocket spending is capped at $2,100 for 2026.

This is part of the multi‑year Medicare drug cost redesign under the Inflation Reduction Act.

What This Means

• Once you spend $2,100 on covered Part D drugs, you pay $0 for the rest of the year.
• This eliminates the old catastrophic phase.
• It applies to all Part D Prescription Drug Plans and Medicare Advantage plans with drug coverage.

Who Benefits Most

• Beneficiaries with chronic conditions
• Those taking brand‑name medications
• Individuals with high‑cost specialty drugs
• Anyone who previously hit the catastrophic phase early

Why January Matters

January is when beneficiaries begin seeing new cost‑sharing rules at the pharmacy. Many will be surprised by lower copays — or confused if their plan isn’t applying the cap correctly.

If you’re unsure how your medications fall under the new rules, reviewing your Part D Prescription Drug Plans page is a smart first step.

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3. First‑Ever Medicare‑Negotiated Drug Prices Take Effect

2026 marks the first year Medicare’s negotiated drug prices hit the market.
According to AARP and CMS, beneficiaries may see up to 50% reductions in out‑of‑pocket costs for the first 10 negotiated drugs.

Drugs Included in the First Round

These include widely used medications such as:

• Eliquis
• Januvia
• Farxiga
• Jardiance
• Xarelto
• And others used for diabetes, heart disease, and blood clot prevention

The Good and the Bad

• Good: Negotiated prices significantly reduce costs for millions.
• Bad: Over 350 other drugs are expected to see price increases in 2026, according to ConsumerAffairs reporting.

Why January Matters

Pharmacies begin applying negotiated prices immediately. Beneficiaries may see lower copays than expected — or confusion if their drug is not one of the negotiated medications.

If you need help understanding how these changes affect your prescriptions, visit our Part D Prescription Drug Plans page or use our Compare Plans tool.

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4. Medicare Advantage Changes for 2026

CMS finalized major Medicare Advantage (MA) and Part D policy updates for 2026 in April 2025.

Key Changes

• Updated payment formulas
• Stricter oversight of supplemental benefits
• New accuracy requirements for provider and pharmacy directories
• Fewer Medicare Advantage plans overall (per GoodRx)
• New special enrollment protections if directory errors misled a beneficiary

What This Means for South Carolina

• Some plans may consolidate or exit the market
• Networks may shrink or shift
• Supplemental benefits (dental, vision, OTC) may be restructured
• Beneficiaries may discover their doctor is no longer in‑network

If you’re reviewing Greenville Medicare, Columbia Medicare, or Charleston Medicare options, these changes may affect your local provider access.

Visit our Medicare Advantage page for a full breakdown of 2026 plan changes.

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5. Part B & Part A Cost Changes

While exact 2026 premiums and deductibles vary, the following trends are confirmed:

Part B

• Premiums typically rise annually
• Deductible adjustments follow inflation

Part A

• Inpatient deductible increases
• Coinsurance amounts adjust for each benefit period

These changes impact hospital stays, skilled nursing, and outpatient services.

If you prefer predictable costs, many beneficiaries explore Medicare Supplement Plans as an alternative to Medicare Advantage.

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6. Social Security COLA for 2026

Social Security benefits increase by 2.8% in January 2026.

Impact on Medicare

• Higher Social Security checks help offset rising Medicare premiums
• But inflation still slightly outpaces COLA

For many retirees, this means tighter budgets despite the increase.

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7. Medicaid & Dual‑Eligible Updates

Newsweek reports significant Medicaid policy shifts in 2026 that may affect dual‑eligible beneficiaries in South Carolina.

Potential Impacts

• Eligibility changes
• Coverage adjustments
• Increased administrative requirements

Dual‑eligible beneficiaries should review their coverage early in the year.

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8. What South Carolina Beneficiaries Should Do in January

1. Review Your Part D Drug Costs

Check whether your medications are affected by:

• The $2,100 cap
• Negotiated drug prices
• Tier changes
• Preferred pharmacy changes

2. Confirm Your Doctors Are Still In‑Network

Especially for Medicare Advantage plans.

3. Review Your Monthly Budget

Factor in:

• New premiums
• New deductibles
• New Social Security COLA

4. Ask for a Plan Review

January is the perfect time to confirm whether your plan still fits your needs.

Use our Compare Plans tool to see which 2026 plan fits your needs.

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9. References

• AARP analysis of 2026 drug price negotiations
• Newsweek: 2026 Medicare & Medicaid changes
• FingerLakes1: Social Security & Medicare 2026 changes
• USA Today: Social Security COLA 2026
• CMS 2026 Medicare Advantage & Part D Final Rule
• Medicare & You 2026 Handbook
• Medicare Tools: 2026 MA & Part D rule changes
• VOR News: 2026 Medicare benefit changes overview
• GoodRx: 2026 Medicare changes summary

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10. Frequently Asked Questions (FAQ)

1. What is the biggest Medicare change in 2026?

The new $2,100 Part D out‑of‑pocket cap and the first‑ever Medicare‑negotiated drug prices.

2. Will my Medicare Advantage plan change in 2026?

Yes — CMS has implemented new rules, and many plans are consolidating or adjusting networks.

3. Are drug prices going down in 2026?

For the first 10 negotiated drugs, yes. But over 350 other drugs may see price increases.

4. Does the Social Security COLA help with Medicare costs?

It helps, but inflation still outpaces the 2.8% increase.

5. Should I review my plan in January?

Absolutely. January is when beneficiaries discover real‑world changes to costs, networks, and drug coverage.

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11. Contact Mauldin Insurance Group

Have questions about your 2026 Medicare coverage?
Need help reviewing your plan or comparing options?

👉 [Contact Us] to speak with a licensed South Carolina Medicare advisor.

Mauldin Insurance Group is South Carolina’s trusted Medicare authority — ready to help you navigate every change in 2026 with clarity and confidence.