In this study, we examined the provision of care to older adults with epilepsy and compliance with the “Quality Indicator for Epilepsy Treatment 15” (QUIET-15) measure. We analyzed 2008–2010, 5% random sample of Medicare beneficiaries augmented with data from all beneficiaries who identified as a minority with claims related to seizures (780.3x) or epilepsy (345.xx). Of 36,912 identified epilepsy cases, 12.6% had ≥ 1 emergency room (ER) visit for seizure(s). For those who presented to ER, among those taking anti-epileptic drugs (AEDs), AED was changed in 15.4%, dose adjusted in 19.7%, and stopped in 14.9%; among those not taking AED, therapy was initiated in 68.5%. In adjusted logistic regressions, African–Americans were more likely to have recurrent seizures than Whites (OR 1.41, 95%CI 1.27–1.56), while Asians were less likely to have recurrent seizures (OR 0.71, 95%CI 0.57–0.89). There were no significant racial/ethnic differences in the likelihood of a post-seizure intervention. The chance of seizure recurrence leading to ER visit decreased with age and increased with the number of comorbidities. Patients with seizure recurrence were more likely to be taking an enzyme-inducing AED (OR 1.69, 95%CI 1.57–1.82) and receiving Part D Low Income Subsidy (OR 1.36, 95%CI 1.22–1.51). The probability of AED change after a seizure was higher for patients with ≥ 4 comorbidities (OR 1.69, 95%CI 1.25–2.27), patients who saw a neurologist (OR 1.49, 95%CI 1.30–1.70), and patients who were taking an enzyme-inducing AED (OR 1.47, 95%CI 1.27–1.71). Overall, a minority of Medicare beneficiaries experienced seizure recurrence that resulted in an ER visit. However, only half of them received treatment concordant with QUIET-15. Though racial differences were observed in occurrence of seizures, none were noted in the provision of care.