Objectives. To examine whether demographic characteristics, health care access, and acute health care utilization differ by age among homeless adults. Methods. We interviewed all 2,175 adult attendees of a citywide homeless outreach event. Results. Older participants were more likely than younger participants to have a regular place for health care (59.8% vs. 44.3%, p<.01), a regular health care provider (53.6% vs. 35.6%, p<.01), and health insurance (45.5% vs. 32.1%, p<.01). Older participants were less likely to be unable to obtain needed health care (15.6% vs. 20.9%, p=.05). In a multivariate analysis, only lack of health insurance predicted inability to obtain needed care (AOR 2.9, CI 1.76–4.8). Conclusions. Older and younger homeless adults have similarly high rates of acute health care utilization. The better access to care among older homeless adults speaks to the importance of insurance in determining access to care among homeless adults.