Fertility transition and increase in longevity across all ages have altered the age composition of households of many low- and middle-income countries. These familial changes have direct implications for individual health, health care, and household well-being. Many of these countries are in transitional phase of universal health coverage and have limited scope of the social security program Using data from Schedule 25.0 of two rounds (60th round in the year 2004 and 75th round in the year 2018) of health surveys conducted, the National Sample Survey Organization (NSSO), India, this study examined the out-of-pocket (OOP) payments and catastrophic health expenditure (CHE) incurred by elderly individuals and households, respectively. The study used bivariate analysis and estimated the incidence and intensity of CHE using the capacity-to-pay approach. The two-part regression model was used to estimate the predicted OOP among elderly and non-elderly households by socioeconomic characteristics. Our findings suggest that, among elderly, the OOP payment at constant prices has increased over time across socioeconomic groups and geography. During 2004 and 2018, the reduction in the incidence of CHE for elderly households was much lower than the non-elderly households. The intensity of CHE has increased for both elderly and non-elderly household, and the increase was higher among the elderly households. A major challenge is to provide quality health services due to the high prevalence of diseases and the impact of multiple morbidities. Including provisions for specific care for the elderly in the “Ayushman Bharat Yojana” is recommended.