If your employer allows spouses to be covered under the employer ICHRA plan, you can use your allowance to cover premiums for both Medicare and individual health plans within your household. This guide explains how to enroll when some family members need Medicare while others need individual coverage.
In either scenario, it’s important to note that the condition for including your spouse is that you are enrolled in a health plan (either an individual plan or a Medicare plan). You cannot cover a spouse’s premium – Medicare or individual – unless you are also covered under your employer’s ICHRA plan.
Whether you qualify for Medicare and your spouse for an individual plan, or vice versa, the guidance and process are similar.
How the Combined Enrollment Process Works
When your household includes both Medicare-eligible members and those needing individual coverage, Zorro's platform now provides an automated, streamlined enrollment process.
Step 1: Start Your Enrollment
Log into Zorro during your election window
Begin the shopping flow
Ensure all household member details are complete and accurate
Step 2: Medicare Eligibility
If anyone in your household is Medicare-eligible based on age, the system automatically routes you to the Medicare enrollment page designed for combination households.
Step 3: Choose Your Path
The system will ask: "Have all members elected their plan?"
YES (Green checkmark): Continue to report your enrollments
NO (Red X): Follow the guided steps below
Enrolling Family Members Who Need Different Coverage Types
For Family Members Needing Individual Plans:
Important: When prompted for employee information, enter the details of the family member who needs individual coverage (not the employee's information)
Example: If you and your spouse have Medicare but your child needs individual coverage, enter your child's information
This ensures you see appropriate plan options for that family member
Note your plan choice
For Family Members Needing Medicare:
Medicare-eligible members must be enrolled in Medicare first
Click the scheduling link to connect with a Medicare Enrollment Expert
Complete your Medicare enrollment during the scheduled call
Obtain confirmation of your coverage
Reporting Your Combined Coverage
Once all family members have their coverage arranged:
Select "I've completed the steps above"
You'll see coverage cards for each family member
For Medicare Coverage (ensure it is marked with the Medicare flag):
Enter:
Medicare insurance company name
Plan type (e.g., Part B, Medigap)
Monthly premium amount
Documentation Required: Include a statement or confirmation with the details of your Medicare plan(s), including:
Carrier
Plan name(s)
Premiums
This can be attached in the submission or emailed to [email protected]
For Individual/Family Coverage:
Enter:
Insurance company name
Plan name (e.g., Gold 2000, Silver 2500)
Monthly premium amount
Finalizing Your Enrollment
Review all entered information carefully, after you click “Submit” you will recive confirmation that:
Plans were submitted successfully
Individual insurance applications are being sent to carriers
Medicare plan details are under review
Payment Process for Combination Households
Payment will be divided based on plan types:
Individual health plans: Pay using the Zorro Pay card that will be issued
Medicare plans: Pay using your personal card or account (Medicare carriers do not accept Zorro Pay)
Zorro will calculate the net across all plans and your allowance. Depending on the amounts, you'll either receive a payroll deduction or reimbursement, viewable in your Zorro dashboard.