Objective: To characterize the health status of older island Puerto Ricans, a segment of the U.S. population that has been largely overlooked in aging research. Method: Data from the 2002 Puerto Rican Elderly Health Conditions Project and the 2002 Health and Retirement Study are used to examine differences in disease, disability, and self-rated health among island Puerto Ricans and the mainland U.S.-born older adult population. Differences are further examined by gender. Results: Island Puerto Ricans were less likely to have heart disease, stroke, lung disease, cancer, activities of daily living (ADL) limitations, and poor self-rated health, but more likely to have hypertension and diabetes. Island Puerto Rican women had worse health relative to island Puerto Rican men. Discussion: Recent challenges in the funding and provision of health care in Puerto Rico are worrisome given the large number of aging island adults, many of whom have hypertension and diabetes, two conditions that require long-term medical care.