Objectives To compare 12-month outpatient healthcare expenditures of at-risk and not-at-risk drinkers aged 60 and older. Design Secondary analysis of data from Project Senior Health and Alcohol Risk Education, a cluster, randomized trial to test the efficacy of an intervention to reduce at-risk drinking. Setting Seven primary care clinics in or near Santa Barbara, California. Participants Current drinkers aged 60 and older who completed a baseline survey (N = 2,779) and did not receive the study intervention, including 628 at-risk drinkers and 2,151 not-at-risk drinkers. Measurements Comparisons of at-risk and not-at-risk drinkers for baseline demographic characteristics, health indicators, alcohol consumption, and adjusted and unadjusted outpatient healthcare expenditures incurred over 12 months after baseline. Results At-risk drinkers were younger, more often male, and more likely to be married and had higher education and incomes than not-at-risk drinkers. Unadjusted 12-month mean outpatient healthcare expenditures were 1,333 ± 2,973 for at-risk drinkers and 1,417 ± 2,952 for the not-at-risk drinkers. There were no statistically significant differences in expenditures between groups before and after controlling for sociodemographic and health characteristics. Conclusion In this short-term study, no adjusted differences in healthcare expenditures were observed between at-risk and not-at-risk older drinkers. Future study is warranted to determine the role of at-risk drinking in long-term healthcare expenditures in older adults. © 2014, The American Geriatrics Society.