OBJECTIVE: The objectives of the study are (i) to examine morbidity patterns, (ii) to explore the treatment-seeking behaviours, and (iii) to analyse the out-of-pocket expenditures (OOPEs) among Indigenous (referred to as tribal in India) elderly in the Visakhapatnam district of Andhra Pradesh, India. METHODS: A cross-sectional survey of 2,103 households was carried out. Data related to socio-demographic, health, and healthcare-seeking behaviours were collected for all the household members. There were 598 people aged 60 years and above in these households. Data on these 598 elderly people were analysed for the present study. RESULTS: The findings highlight the socioeconomic hardships of the tribal elderly, including reliance on labour-intensive work, low educational attainment, and high rates of widowhood. Data on the illnesses experienced in the past year revealed that 277 (46.3%) of the elderly experienced acute illnesses. Chronic conditions were present in 224 (37.5%) while 115 (19.2%) had musculoskeletal pain and 75 (12.5%) had hypertension. Multimorbidity was present in 29 (4.5%) of the elderly. A total of 226 (81.6%) sought care from government facilities for acute illnesses. For chronic illnesses, while 109 (48.7%) did not seek treatment, 88 (39.3%) relied on government healthcare facilities. Regarding hospitalisation, 12 (70.6%) were admitted in government facilities and five (29.4%) were admitted in private hospitals. The OOPEs were high when they sought care from private healthcare facilities. For acute illnesses, while the average (5% trimmed mean) OOPE was Indian rupee (INR) 254 when seeking care from government healthcare facilities, it was INR 4301 when seeking care from private facilities. For chronic illnesses, the expenditure for private healthcare (5% trimmed mean = INR 3403) was higher than when seeking care from government healthcare facilities (5% trimmed mean = INR 262). The average (5% trimmed mean) for hospitalisation was INR 6414 when admitted to government hospitals, and it was INR 46063 for private hospital admissions. CONCLUSIONS: The illness burden is high among the tribal elderly. The OOPEs were high, particularly when seeking care from private healthcare facilities. The study emphasises the need to strengthen government healthcare services, particularly through health and wellness centres under India's Ayushman Bharat programme. Access to government social support schemes such as old age pensions and health insurance should be improved. Health education and community partnerships are to be strengthened. Addressing these gaps is vital to alleviating health disparities among the tribal elderly and securing their access to India's universal health coverage framework.