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.