Background <p>Health insurance is essential for providing access to healthcare, particularly for older individuals. Disparities in awareness and understanding among elderly individuals in urban and rural areas may impact their ability to effectively utilize these services.</p> Objective <p>This study aimed to compare knowledge of health insurance among urban and rural elderly populations.</p> Methods <p>A cross-sectional study was conducted among 208 respondents in Dhaka and Chittagong. The data were analyzed using descriptive statistics, graphs, Chi-squared tests, and a multivariable logistic regression model.</p> Results <p>Most participants were male (60.6%), with 94.7% of comorbidities positive. About 60% of urban and 50.5% of rural people used monthly savings for health expenses. The term "health insurance" was known to 75% of urban and 49% of rural respondents. The Chi-squared test revealed that knowledge of health insurance was significantly associated with current employment status, housing ownership, monthly family income, formal education status, marital status, family type, and monthly medical costs. Multivariable analysis indicated that rural residents were 55% less likely to have knowledge of health insurance compared to urban residents. Those without housing ownership, who rented, or had other housing arrangements were 63% less likely to have knowledge of health insurance compared to homeowners. Additionally, currently employed respondents were 60% less likely to have knowledge of health insurance compared to retired individuals.</p> Conclusion <p>The findings point out the need for elderly-specific policies and programs to enhance awareness and improve access to health insurance, ultimately contributing to universal health coverage.</p>