This study examined how health inequalities with respect to income have changed among older adults in Japan from 2001 to 2022. The past two decades have witnessed a series of public pension reforms and increased labor force participation among older individuals. The pro-rich concentration of good health has become less clear for self-rated health and activities of daily living among older men. However, income-related inequality in stress/anxiety increased over time in men, and no clear trend was observed for health deficiencies or conditions. Compared to men, women showed more mixed results, with widening inequalities in health deficiencies and conditions.