Background <p>The COVID-19 pandemic may negatively impact the accessibility of medical care in China. This cross-sectional study aimed to identify the factors associated with unmet medical needs among middle-aged and older adults in China during the COVID-19 Pandemic.</p> Methods <p>A cross-sectional analysis using data from the 2020 China Health and Retirement Longitudinal Study. The final sample consisted of 19,361 individuals. Multiple imputation was applied to handle missing values. A binary logistic regression, stratified by rurality, was used to examine factors associated with unmet medical needs.</p> Results <p>During the COVID-19 Pandemic, 11.3% of middle-aged and older adults did not receive needed medical care. In both urban and rural areas, middle-aged and older adults who were female, with higher educational attainment, rated poor health, suffering from chronic conditions, and often felt fears were associated with a higher likelihood of unmet medical needs. In urban areas, middle-aged and older adults with urban employee medical insurance (OR = 2.15, 95% CI: 1.33, 3.48) were more likely to have unmet medical needs compared to middle-aged and older adults without insurance. In rural areas, older adults over 75 years of age (OR = 0.52, 95% CI: 0.39, 0.69) were less likely to have unmet medical needs, and middle-aged and older adults who knew the preventive measures (OR = 1.97, 95% CI: 1.29, 3.01) had a higher probability of having unmet medical needs.</p> Conclusions <p>The findings indicate gender, age, educational attainment, occupation, Living with a spouse, health insurance, number of health technicians per 10,000, self-rated health, chronic conditions, depression, knowing the preventive measures, and fear of pandemic associated with unmet medical needs. The unmet medical needs of vulnerable groups should receive priority attention in the future and facilitate rationalizing the allocation structure of medical resources.</p>