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The math is identical only the inputs change

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An individual can be enrolled in their own health insurance plan (such as through their employer or a Federal or state healthcare exchange) or covered by someone else's plan (e.g., covered by their spouse's employer-provided health insurance or, for non-dependent children age 26 or younger, a parent's health insurance plan), but no matter who 'owns' the insurance, the policy needs to meet the HDHP criteria to allow those it covers to be eligible for HSA contributions

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The upshot to both spouses having family HDHP coverage, despite one spouse also being covered by Medicare, is that it allows the non-Medicare-covered spouse to contribute up to the maximum family contribution to their HSA, rather than being limited to the self-only maximum