A Thesis Submitted to Mzumbe University School of Public Administration and Management in a Partial Fulfillment of Requirement for the Award of Master of Health Systems Management (MHSM).There is a clear indication that older people need special treatment and care, as they grow older. Again, since most of the elderly are poor, they cannot access health services due to institutional barriers. Different health policies and initiatives geared toward promoting good health, older people are still failing to access quality health care in the country. Again, available literature has not addressed the issue of insurance and the elderly. Thus the aim of this study was to analyze the contribution of health insurance on the access and utilization of health care services by the elderly in Ilemela District. The study targeted the population of elderly people aged 60 years and above, health practitioners and administrators. A total of 278 respondents were involved in the study and they were selected by using simple random, convenient, and purposive sampling techniques. Data were collected through focus group discussions (FGD), questionnaires, and interviews. The collected data were analyzed by both qualitative and quantitative techniques, in which qualitative data were subjected to content analysis while quantitative data were analysed using Statistical Package for Social Sciences (SPSS) to produce percentages and frequencies, then exported to excel to produce tables and figures. The findings show that health insurance influenced elderly access and utilization of health care services. However, the usefulness of health insurance is objected by lack of awareness, shortage of skilled personnel, long waiting time, shortage of medicine, unharmonized government self-managed insurance fund, limited insurance schemes in rural areas, and unclear health insurance service packages. In conclusion, the study recommends increasing awareness of elderly people regarding health insurance and its usefulness particularly among the elderly living in the rural areas. When increasing insurance coverage, strategic efforts should also be made to improve the training and employment of health workers with gerontological skills, availability of essential medicine in order to encourage more people to join the insurance scheme