Access to healthcare is key to aging well. Prior research demonstrates disparities in access over the lifecourse, but few include sexual and gender diverse (SGD) groups. Problematizing the exclusion of gender minorities, this study examines data from a probability-based sample of adults 65 and older, living in 43 U.S. states from 2014-2020 and asks whether gender identity and sexual orientation shape healthcare access. I test four outcomes––having insurance, a doctor, a recent checkup, and care affordability––presenting predicted probabilities from logistic regression models. I progressively complicate how identity is measured, stratifying results by gender and sexual orientation, revealing variation depending on measurement. Comparing “trans” to “cisgender” obscures vulnerabilities. Gender nonconforming elders had worse healthcare access if they reported female sex. Transgender elders had the lowest rates of access if they were also bisexual. Findings demonstrate the utility of combining gender and sexual identity in describing patterns of disadvantage.