Routine engagement in healthy behaviors may improve quality of life in older adults with chronic disabling conditions, such as multiple sclerosis (MS). However, older adults with chronic conditions may face many barriers to engaging in healthy behaviors. Health promotion and wellness services may help older adults with chronic conditions engage in healthy behaviors. Thus, the purpose of this study was to identify factors associated with the use of and unmet needs for heath promotion services among middle-aged and older adults with MS. Data from a cross-sectional telephone survey of individuals aging with MS in the mid-west USA were used for this study (n = 1282). A multinomial regression model was used to identify variables associated with the utilization of health promotion services. A logistic regression model was used to identify variables associated with unmet needs for these services. Females (OR = 1.51; CI: 1.13, 2.00), high school graduates (OR = 1.77; CI: 1.34, 2.34) and people who reported no problems with mobility or balance (OR = 1.68; CI: 1.12, 2.51) were more likely to utilize health promotion and wellness services. Factors that increased the likelihood of reporting an unmet need for these services were being female (OR = 2.34; CI: 1.56, 3.51), greater than a high school education (OR = 1.58; CI: 1.14, 2.20), not being married (OR = 1.79; CI: 1.31, 2.43), having inadequate income (OR = 1.83; CI: 1.31, 2.56), experiencing pain (OR = 1.96; CI: 1.34, 2.87) and reporting less ability to do everyday activities now compared with 1 year ago (OR = 2.13; CI: 1.16, 3.92). To avoid widening the health-disparities gap, future research needs to explore strategies that promote utilization of health promotion services among all middle-aged and older adults with MS.