While politicians and media outlets debate what to do about Medicare, one change has already come to the federal program: High-income seniors are paying more for Medicare Part B, which covers doctors’ visits and outpatient care. While many seniors pay $96.40 a month for this coverage, beneficiaries in the top tier pay $369.10, almost four times as much, for the same services.

“We project that 14 percent of Medicare Part B enrollees will be subject to the income-related Part B premium in 2019, up from 5 percent in 2011,” said Craig Palosky, director of communications for the Kaiser Family Foundation, according to Investor’s Business Daily.

High-income beneficiaries also pay more for Part D, the drug benefit. While most seniors pay the standard amounts charged by insurers in the various states, high-income enrollees pay that rate plus a surcharge of up to $69.10 per month.

And what is “high-income“? For beneficiaries with modified adjusted gross incomes of over $85,000 for single filers, beneficiaries pay no surcharge. Surcharges begin at $85,000 and continue upward at $107,000 and $160,000. For modified adjusted gross incomes of $214,000 and above, beneficiaries pay the maximum.

When planning for health care expenses, Medicare beneficiaries should budget for these additional expenses. Income thresholds are based on tax figures from two years previous. (Beneficiaries’ 2011 premiums are determined at the end of 2010 and based on modified adjusted gross incomes for tax year 2009.) Appeals for certain situations, such as marriage, divorce, widowhood or reduced working hours, may be granted.

For more on rich Medicare premiums, see:

Rich Medicare seniors: get ready to pay more

Medicare drug plan premiums to rise

Medicare Advantage getting more expensive