To amend part A of title XVIII of the Social Security Act with respect to the premium amounts for those enrolled under such part and to amend section 218(n) of such Act to provide for a transition in the case of voluntary agreements for coverage of State and local employees under medicare.

Amends title II (Old Age, Survivors and Disability Insurance) of the Social Security Act to credit State and local employees who held such employment prior to and after the State's decision to opt into the Medicare program (title XVIII of the Social Security Act) with such prior employment for the purpose of determining their eligibility for benefits under part A (Hospital Insurance) of the Medicare program.

Establishes specified monthly part A premiums for calendar years 1992 through 1996, with premiums thereafter determined by the Secretary of Health and Human Services and indexed to the increase in the part A deductible.