Ageing and the associated burden of non-communicable diseases (NCDs) are increasing disproportionately in low- and middle-income countries. In addition to that, multiple chronic conditions (MCCs) among the aged population are considered one of the key emerging concerns of health systems globally. This has made the prevention and management of NCDs a global priority and a major challenge to limited social and health care systems. Utilizing the nationally representative health consumption data from the National Sample Survey (2017–2018), this study investigates the growing prevalence of multiple chronic conditions and co-morbidities, particularly among the elderly in India with stretched public primary health care systems. This study brings out distinct dissimilarities in the equity aspect and incidence of the burden from out-of-pocket expenses as well as catastrophic health expenditures on health care across the states and at the national level. Multiple chronic conditions among the elderly emerge as one of the important predictors of overall inequality in health care use and access. Moreover, these conditions create a higher predisposition to incur disproportionately higher medical expenditures. The population, especially the elderly suffering from MCCs, intensifies more structural inequalities in the welfare distribution, acknowledging its typical gradient and patterns among the elderly.