If spouse only had Medicare it would be deductible ( her deduction has nothing to do with policy holder name) Cannot be included, because she has her employer coverage. I believe you are over thinking it. If spouse or TP has employer coverage then you cannot use any premiums paid by the one that has employer coverage. If nether had employer coverage then all premiums are deductible. That is the way I've done it. Could be wrong, but never had an issue come up.