OBJECTIVES: The distribution of free samples to patients in the US, the retail value of which is US$20 billion annually, is controversial. Proponents assert that free samples improve medication access for low-income patients while opponents argue free sample availability drives the choice of expensive, brand-name pharmaceuticals. It is critical to shed light on the benefits and costs of free samples for older adults, in particular, given their high drug cost burden. Our objective was to determine the proportion of older adults receiving free samples, and to examine the association between free sample receipt and communication with physicians and cost-related non-adherence to medicines. METHODS: In 2006, we conducted a national telephone survey of persons age 65 and older in the U.S., over-sampling those with low-incomes. The survey included several questions related to prescription drug insurance coverage, medication use and doctor-patient communication. RESULTS: Half of older adults surveyed had received free samples from their doctors at least once in the past 12 months, with 21% receiving samples more than once. Two thirds of seniors who had talked to their doctor about the cost of medicines they are taking received free samples compared to 43% of those who did not have such discussions. Seniors who received free samples were less likely to agree there is nothing their doctor can do to help lower drug costs (40% vs. 47%) than those who did not receive samples. Free sample receipt was associated with a lower risk of cost-related non-adherence (failing to fill prescriptions, skipping or reducing doses due to cost) (31% vs. 26%).  CONCLUSIONS: Receipt of free samples is common among older adults and appears to increase with discussions of drug costs between doctors and patients. Free sample receipt may help reduce cost-related non-adherence, however, further study is needed to shed light on these behaviors.