BASIC (12-03)

All States can execute a Section 218 Agreement with SSA to provide Medicare Hospital Insurance (HI) only coverage for employees who have been in continuous employment with the same employer since before April 1, 1986, and are members of a public retirement system. Employees who were hired prior to April 1, 1986, and who are not currently paying into Medicare, may not make Medicare contributions if the employee is not covered for Medicare under a Section 218 Agreement.

A. PUBLIC LAW 99-272 (SECTION 13205)

All States may obtain, through a Section 218 Agreement with SSA, Medicare HI coverage for State and local government employees who were hired before April 1, 1986 and are not mandatorily covered for Medicare. Medicare HI-only coverage under a Section 218 Agreement cannot begin before April 1, 1986.

B. REFERENDUM RULES

The same referendum and modification rules for Social Security and Medicare coverage under Section 218 apply to voluntary Medicare HI-only coverage. For example, if the State is authorized to conduct a divided vote retirement system referendum, the State may use the divided vote procedure to provide Medicare HI-only coverage. If a State or local government employee is mandatorily covered for Medicare when a referendum is conducted for Section 218(n) Medicare HI-only for other employees of the same employing entity, the employee is not eligible to vote in the referendum.

The mandatory exclusions from Medicare coverage also apply to Medicare HI coverage under a Section 218 Agreement. The State may elect Section 218 optional exclusions.

NOTE: Medicare HI-only coverage under a Section 218 Agreement is extended to the employee and not the position.