OBJECTIVES: With a concern about health disparity among the elderly with different economic status, we compared the prevalence and health care utilization for hip fracture, which is a serious and common condition in the elderly, between the National Health Insurance (NHI) and the Medical Aid (MA) beneficiaries aged above 64. Korea has a two-tiered national health security program: premium-based NHI and government subsidized MA program. METHODS: The 2016 Health Insurance Review and Assessment Service-Adult Patient Sample (HIRA-APS) data, composed of 20% random sample of patients aged above 64 in Korea, were used to identify those having claim record with a diagnosis of hip fracture (ICD-10 codes of 72.0x and 72.1x). Age-and gender-specific prevalence and health care utilization for hip fracture were compared between the NHI and the MA beneficiaries. RESULTS: The annual prevalence rate of hip fracture aged above 64 was 621.9 per 10,000 MA beneficiaries and 377.6 per 10,000 NHI beneficiaries, yielding a MA to NHI ratio of 1.65. The prevalence gap between the two groups was higher in the young elderly (a MA to NHI ratio of 2.29 in 65-69 years old, 2.28 in 70-74 years old, 1.46 in 75-79 years old) than in the oldest elderly (1.09 in ≥ 80 years old), and higher in men (1.70) than in women (1.49). The average annual number of hospital admissions (1.58 in MA vs. 1.67 in NHI) and outpatient visits (2.21 in MA vs. 2.14 in NHI) per patient with hip fracture were similar between the two groups. CONCLUSIONS: The higher prevalence of hip fracture enrolled in MA than NHI suggests unfavorable health disparity in the poor elderly population. However, similar health care utilization for hip fracture between the two groups implies little inequity in health care services according to the economic status of the elderly in South Korea.