The monthly Medicare premium paid by about 40 million seniors and disabled people will climb 5.6 percent next year, to $93.50, but will leap by as much as 83 percent for the wealthiest of them.

For the first time, the monthly cost of so-called Part B coverage for doctor and outpatient bills will be pegged to income, as Medicare attempts to address mounting financial problems, federal officials said Tuesday.

Individuals with incomes more than $80,000 -- 4 to 5 percent of all recipients -- will pay more than the rest of the Medicare population starting Jan. 1, and will be paying 40 to 320 percent more by the time the plan is fully phased in as of 2009.

Some analysts and recipients predict wealthy seniors will abandon Medicare for private insurance rather than pay the higher premiums, leaving the program with sicker and poorer recipients.

His office projects 30,000 seniors would leave Medicare by 2010, of about 1.2 million high-income seniors affected by the premium surcharge. Even the highest income seniors paying top premiums would still get a subsidy on health care from Medicare.

"I don't see any substantial adverse impacts on the service beneficiaries receive, and I do see a substantial positive affect" for the program's long-term survival, McClellan said.

Officials had no figures for how many of the 500,000 Medicare recipients in Broward and Palm Beach counties would pay the high-income surcharge.

Tying monthly premiums to income does not sit well with some seniors, who have viewed Medicare as a program for all rather than one offering more help to lower income people.

"It shouldn't be a different for different folks," said retiree Allan Gluckstern, who lives west of Boca Raton and declined to say whether he and his wife, Evelyn, would have to pay higher premiums. "Tax the rich, fine. They pay their fair share and maybe more than their fair share, but [Medicare] should be more efficient and tied to service rather than income."

Congress approved the surcharge on wealthier beneficiaries in 2003 when it passed the Medicare prescription drug benefit that started this year.

In addition to the rise in Part B premiums, recipients will see Part B deductible rise $7 a year, to $131, and their Part A (hospitalization) deductible rise $40, to $992 per stay.

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