This article analyzes social inequalities in health care services utilization by the elderly and tests the influence of place of residence. The study was based on a sample survey of residents 60 years of age and older from three different areas in the city of Rio de Janeiro. The multi-stage sampling method led to violations of the logistic regression assumptions which were considered in the data analysis stage. Need was the most important factor related to utilization. However, gender, type of service, income, and place of residence also showed positive impact on health care utilization. Moreover, the effect of the income was modified by place of residence. The area with the best living conditions (Copacabana) did not show inequalities in health care services utilization. The income gradient was more important in middle and lower-income areas, i.e., Méier and Santa Cruz, respectively.