To assess insomnia and its health correlates among elderly primary care patients in India. A multicenter, cross-sectional survey was administered to 1,770 elderly primary care patients from 71 government primary health centers in Kerala, India, from May to December 2016. Insomnia was evaluated using the Insomnia Severity Index. Basic demographics and information about medical illness were collected. Study instruments included the Patient Health Questionnaire-Somatic, Anxiety, and Depression Symptoms; Alcohol Use Disorders Identification Test; Fagerström Test for Nicotine Dependence; 12-item World Health Organization Disability Assessment Schedule; and World Health Organization Quality of Life-BREF. Valid responses were received from 1,574 (89%) patients, of whom the mean age was 68.6 years and 55.5% were women. Clinical insomnia was reported by 11.8%, whereas 30.4% had subclinical insomnia. Primary care attendees with subclinical as well as clinical insomnia had increased odds of being older and female and having chronic medical illness compared with those without insomnia. Patients with clinical insomnia had increased odds of common mental disorders (anxiety, depression, and somatization) and greater disability compared with the subclinical or no insomnia groups. Those with subclinical insomnia had poor satisfaction with life compared to those with no insomnia. Insomnia in the elderly is frequent in primary care patients in India and has multiple negative health correlates. This study reiterates the need for more awareness with regard to detection and management of insomnia in the elderly population.