An estimated 58,000 older Utahns will have to make some hard choices if Congress approves proposed Medicare budget cuts.

They are the people who have too much income to qualify for Medicaid but don't have enough money to simply absorb the increase in Medicare premiums or the nearly doubled deductions, according to Jim Wordelman, associate director of Salt Lake County Aging Services.Under the budget compromise plan, Medicare premiums would rise from $28.60 a month to $55 a month by 1995. The $75 deductible for Part B, physician costs, would increase to $150. The Part A - hospital - portion would stay the same.

Nationwide, at least 5 million older Americans may feel the pinch.

"We're very concerned," said Lee White, Associate Area Representative for the American Association of Retired Persons. "We're concerned because they are impinging cuts on individuals who are already having a hard time making ends meet.

"There are many wealthy older people. But there are many, many more who will be hurt. We're getting calls from people who say they are prepared to shoulder their part of the burden, but it is unfair to the poor and disabled who are having trouble making ends meet. It's going to be incredibly difficult," he said. "We see many other ways to reduce the deficit than going after those who are already hurting."

Horace Deets, national director of AARP, this week issued a statement of concern that half of the deficit reduction planned comes from entitlement programs.

Deets has asked Congress to soften the effects for those senior citizens to whom health care is unaffordable.

"We're not talking about people with thousands of dollars stockpiled," White said. "These people have a difficult time even affording basics. I'm afraid we'll see people decide to drop Part B and hope they won't need it."

When Medicare was introduced in 1965, the average senior citizen spent about 15 percent of his income on medical expenses. That percentage has since risen. Now senior citizens are wondering, "Is there an end in sight? If it goes to $55, is that the end or will it rise even more?" White said.

Wordelman said the Medicare system already is facing a lot of pressure. A $3.1 billion cut in provider rates already has been planned. Some doctors are expected to respond to that by refusing to accept Medicare's approved cost as their charges. Other doctors may pass the cost on to the rest of the population.

Wordelman also pointed out that many senior citizens drive older, larger cars. So they'll also be "taking hits" on rising gas taxes, particularly in rural areas where there's no mass transportation.

Physicians recently have been ordered to do all of the billing paperwork for Medicare, a mandate that relieves patients but may make some doctors less inclined to treat Medicare patients.

There's an unanswered question, as well. Would the cost of supplemental, "Medigap" insurance rise if deductibles do?

The consensus seems to be yes. "The cost of Medigap insurance is already going up," White said. "If this measure passes, it will go higher."