BACKGROUND: The purpose was to investigate the impact of social determinants of health on healthcare utilization among older adults in two cognition groups: normal and dementia/impaired cognition. METHODS: We used cross-sectional data from the Health and Retirement Study (N = 16,339) to assess healthcare utilization: hospital stay, nursing home stay, hospice care, and doctor visits. The respondents were classified into two cognition groups using the Langa-Weir approach. RESULTS: A cohort comparison between normal (mean age = 66.1) and dementia/impaired cognition (mean age = 71.9) groups revealed dementia/impaired group included more individuals from racial and ethnic minorities (42.7 % Black/Other, 20.8 % Hispanic) compared to the normal cognition (24.7 % Black/Other, 12.1 % Hispanic). They experienced longer hospital, nursing home, and hospice stays and varied doctor visit frequencies. These differences were influenced by race, age, marital status, education, and rurality. CONCLUSION: Social determinants of health play an important role in predicting disparities in healthcare utilization among older adults across cognition levels.