OBJECTIVES: Lack of health insurance is associated with higher morbidity and mortality rates in near-elderly adults with chronic conditions such as hypertension, hyperlipidemia, and diabetes. This study examines the association between insurance coverage and ambulatory care for the near elderly, ages 55 to 64, with hypertension. METHODS: Data from the 1999-2003 National Ambulatory Medical Care Survey (NAMCS) and outpatient department (OPD) component of the National Hospital Ambulatory Medical Care Survey (NHAMCS) were combined for this study. NAMCS/NHAMCS data were obtained from a sample of patient visits to office-based physicians (NAMCS) or hospital OPDs (NHAMCS) during a randomly assigned reporting period throughout the year. Hypertension visits were identified as visits with an ICD-9 of 401 listed as first, second, or third diagnosis. Our study sample was limited to those age 55 to 64 at the time of the visit. We examined the types of drugs, health screenings, and health counseling provided at the vist. Insurance coverage was defined as having an expected source of payment as public or private health insurance and uninsured defined as self-pay or charity care. We tested for differences by insurance coverage using t-test statistics with SUDAAN software to account for complex survey design. RESULTS: Among the near elderly visits with diagnosis of hypertension the uninsured were less likely to receive cholesterol screening (9.6% vs. 17.7%), exercise counseling (13.3% vs. 24.3%), diet and nutrition counseling (25.2% vs. 33.9%), and prescribed less ACE Inhibitors (19.9/100 visits vs. 26.8/100 visits). CONCLUSION: These preliminary results found that ambulatory visits made by the uninsured near elderly with hypertension are associated with fewer health screenings, counseling, and prescription of ACE Inhibitors. This age group will be on Medicare within the next 10 years and lack of proper management of their chronic conditions may result in an excessive cost burden on Medicare.