The objective is to analyze the coverage and efficiency of attention by the state social security institutions to the most prevalent diseases in older adults (AM) from Hidalgo, Mexico. This is a transversal-descriptive study constituted by 2503 AM participants of the Health and Wellbeing Survey Hidalgo 2014. A random sampling was conducted in private residences of urban and rural areas of the state. The results show that 95.6% of AMs have health coverage. The most prevalent diseases are: arterial hypertension, diabetes mellitus and joint disease; however, 17.09%, 13.29% and 48.38% of AMs, respectively, do not receive treatment against these diseases. In addition to this, 68% of participants do not perceive improvement in their state of health after being treated in the last year. Conclusions indicate that although there are important advances in health coverage, significant deficiencies are still seen in the quality of care, supply and accessibility to health institutions, which translates into therapeutic abandonment and user dissatisfaction.