Older adulthood is a crucial time in the health management journeys of transgender and non-binary (TNB) people. Understanding how the COVID-19 pandemic has impacted TNB older patients (65 years and over) offers critical guidance for successful health services reform and continued delivery systems change. Using qualitative data from 47 semi-structured individual interviews, I investigate how TNB older Americans-as a medically and socially vulnerable population in the United States-manage their health during the COVID-19 pandemic. Results indicated a need for enhancing health services and resources for TNB older adults while creating a culture of age-friendly and gender-affirming healthcare. Four primary themes emerged: (1) exacerbated mental health challenges, (2) disrupted social relationships and support, (3) adopting cost-effective health management strategies, and (4) incorporating family care partners in health management. Such themes were shaped by respondents’ privileged and marginalized social locations, such as access to financial security, social support, and adequate medical care. Although these research findings should not be generalized to the TNB older adult population, they suggest that broader patterns of inequity affect how TNB older Americans manage their health during the COVID-19 pandemic.