Healthcare ad targeting: age, sex, race, language

Ad platforms let a practice choose who sees an ad: an age bracket, a gender, a language, a radius around the office. For a mammography reminder or a pediatric practice, narrowing the audience looks like plain good sense. For other choices, such as leaving out a neighborhood or a group of people, the same settings can raise civil rights questions. This guide covers where the lines are for practices that run ads on Google, Facebook and Instagram.

Three related topics have their own guides. Language access duties and ads written in other languages are in our guide to Spanish-language medical marketing, the notices a covered practice posts are in Section 1557 notices on a practice website, and sexual orientation and gender identity in ads are covered in our guide to LGBTQ-inclusive practice marketing. For the health targeting limits on Spotify and Amazon Music, see our guide to streaming audio ads. For how these limits apply to audience signals in Google’s all-channel campaigns, see our guide to Performance Max for healthcare advertisers. For 18+ targeting rules on Snapchat, see Snapchat ads for medical practices.

This is general information, not legal advice. Sources cited were checked on October 31, 2026: 42 USC 18116; 45 CFR 92.1, 92.2, 92.4, 92.101 and 92.201; the HHS notice of court decision published June 2, 2026 (91 FR 32887); 42 USC 6102 and 45 CFR 91.11, 91.13 and 91.14; 45 CFR 80.3; 16 CFR 14.9; New York Executive Law 292(9) and 296(2); Washington RCW 49.60.040 and 49.60.215; California Civil Code 51; the Google Ads policy on restricted targeting in personalized advertising and its help page on demographic targeting; Meta’s announcement of November 9, 2021 on removing detailed targeting options; and the U.S. Preventive Services Task Force recommendations on colorectal and breast cancer screening. We found no federal rule or agency guidance written for ad targeting by health care providers as such; the rules below apply to it because of who runs the ad and what the ad offers. State law differs and changes. Have a health care attorney review your targeting plan, especially before you exclude any group.

The short version

Section 1557 bars discrimination on the basis of race, color, national origin, sex, age and disability in health programs and activities that receive federal financial assistance (42 USC 18116, 45 CFR 92.101). For a physician’s practice, the rule’s definition of a health program or activity reaches all of its operations (45 CFR 92.4).
Targeting decides who sees an ad. It does not decide who may book. Keep the service, the booking page and the phone line open to anyone the practice treats.
Age targeting tied to a clinical reason, such as screening age ranges in U.S. Preventive Services Task Force recommendations, fits the purpose of the ad. The Age Act rules allow age distinctions in narrow cases (45 CFR 91.13, 91.14), and we found no OCR guidance applying them to ads.
Race targeting is not an option to look for. Google lists race and ethnicity as a sensitive interest category, and Meta announced in 2021 that it would remove detailed targeting options relating to race or ethnicity.
Google lists health as a sensitive interest category, so health ads cannot use advertiser-curated audiences such as customer match, your data segments or lookalike segments. Demographics, location and predefined Google audiences remain available.
Job ads are different. Google does not allow age, gender, marital status or parental status targeting, or ZIP code targeting, for employment ads in the United States and Canada.
State public accommodation laws in New York, Washington and California reach medical offices, and New York’s law reaches the wording of ads too (N.Y. Exec. Law 296(2)(a)).

Does Section 1557 reach your ads?

Section 1557 of the Affordable Care Act says a person may not, on a ground prohibited by Title VI, Title IX, the Age Discrimination Act or section 504, be excluded from, denied the benefits of, or subjected to discrimination under any health program or activity any part of which receives federal financial assistance (42 USC 18116(a)). The HHS rule lists the grounds as race, color, national origin, sex, age and disability (45 CFR 92.1, 92.101(a)(1)).

Two parts of the rule matter for advertising. First, it applies to each health program or activity any part of which receives federal financial assistance from HHS (45 CFR 92.2(a)). Whether your practice is a recipient is a legal question; our Section 1557 notices guide covers how HHS now reads Medicare Part B payments. Second, for an entity principally engaged in providing health care, including a physician’s practice, the definition of a health program or activity covers all of its operations (45 CFR 92.4). Marketing is one of those operations.

The rule does not mention advertising or ad targeting by name, and we found no OCR guidance on how it applies to them. The safest reading is to treat an ad campaign the way you treat the front desk: it may describe a service and aim at the people likely to need it, but it should not be the means by which a protected group is kept away from care.

One part of the rule has changed. On October 22, 2025, a federal court vacated provisions of the 2024 rule to the extent they extend sex discrimination to gender identity, including 45 CFR 92.101(a)(2)(iv), and HHS said in a notice published June 2, 2026 that it will not enforce the vacated provisions (91 FR 32887). The rest of the rule remains in force, according to that notice.

Age: where targeting fits the service

The Age Discrimination Act bars discrimination on the basis of age in programs and activities receiving federal financial assistance (42 USC 6102), and Section 1557 carries it into health programs. Under the HHS Age Act rules, a recipient may not use age distinctions that have the effect of excluding people or of denying or limiting their opportunity to participate (45 CFR 91.11(b)).

The same rules set two exceptions. An action may take age into account where age is used to approximate another characteristic that has to be measured for the program to run normally, can reasonably be approximated by age, and is impractical to measure person by person (45 CFR 91.13). An action may also rest on a factor other than age, even with uneven effects by age, if the factor bears a direct and substantial relationship to the normal operation of the program (45 CFR 91.14).

Screening campaigns are the clearest example of an age-based audience with a clinical reason. The U.S. Preventive Services Task Force recommends screening adults aged 45 to 75 for colorectal cancer (final recommendation of May 18, 2021) and recommends screening mammography once each two years for women aged 40 to 74 (final recommendation of April 30, 2024). A recall campaign for those screenings aimed at those ages matches the recommendation the ad is built on.

Two practical points follow. Google’s age brackets for demographic targeting are 18 to 24, 25 to 34, 35 to 44, 45 to 54, 55 to 64, 65 and up, and unknown, so they will not match a guideline exactly; choose the brackets that cover the recommendation and let the landing page explain who the screening is for. And Google’s help page explains that demographic targeting prevents people outside the chosen groups from seeing the ad, so excluding the unknown bracket also removes people whose age Google does not know.

Google’s personalized advertising policy also says that users under 18 are not eligible for personalized advertising of any kind. A pediatric practice reaches parents, not children; Google offers parental status as a demographic option.

Sex: aim the message, do not close the door

Title IX, as carried into Section 1557, covers sex. The rule describes sex discrimination as including discrimination on the basis of sex characteristics, pregnancy or related conditions, sexual orientation and sex stereotypes, along with gender identity in the provision the court vacated (45 CFR 92.101(a)(2)).

Google’s own help page on demographic targeting gives the example of a fitness studio for women using gender targeting to avoid showing its ads to men. For a practice, a campaign about mammography or prenatal care aimed at women describes who the service is for. The risk lies in the copy and the intake, not the audience setting: an ad or a booking page that tells a person of another sex that they are not welcome is a different act from an ad aimed where it is relevant.

Remember the gaps in the data, too. Google’s gender targeting includes an unknown group. A person outside the audience you picked may still search for the service and find your site, and the practice should be ready to help them.

Race and national origin: no audience setting to use

Title VI rules bar a recipient from denying a service on the ground of race, color or national origin, from providing a different service or providing it in a different manner, and from denying an opportunity to participate or offering one that differs from what others get (45 CFR 80.3(b)(1)(i), (ii), (vi)). They also bar picking the site or location of facilities with the purpose of excluding people on those grounds (45 CFR 80.3(b)(3)).

The platforms have closed the direct route. Google’s personalized advertising policy lists race and ethnicity among its sensitive interest categories, and Meta announced on November 9, 2021 that starting January 19, 2022 it would remove detailed targeting options referencing causes, organizations or public figures that relate to health, race or ethnicity, political affiliation, religion or sexual orientation. The indirect route is the one to watch. No federal rule we found addresses ZIP code or radius targeting by a health care provider, and Google’s policy bars ZIP code targeting for housing, employment and consumer finance ads, a list that does not include health. We recommend that a practice draw its service area by travel distance and the locations it serves, write that reason down, and not add or remove neighborhoods because of who lives there.

Language: reaching people is welcome, but the duties follow

Under Section 1557, a covered practice must take reasonable steps to provide meaningful access to each person with limited English proficiency eligible to be served or likely to be directly affected by its health programs and activities (45 CFR 92.201(a)). Targeting an ad in Spanish, Vietnamese or another language to the people who speak it fits that goal. We found no rule that requires a practice to advertise in each language its patients speak.

The duty comes when the person responds. If an ad in another language brings in a caller, the language assistance rules in 92.201 apply to the call and the visit, and the FTC’s policy statement says that where a disclosure is required, it appears in the language of the target audience, ordinarily the language principally used in the ad (16 CFR 14.9(a)). Our Spanish-language marketing guide covers both in detail.

Excluding by language is another matter. Section 1557’s notice rules treat national origin as including limited English proficiency and primary language (45 CFR 92.10(a)(1)(i)), and California’s Unruh Civil Rights Act lists primary language among the grounds it protects (Cal. Civ. Code 51(b)). A campaign that keeps an existing service away from speakers of a language is harder to defend than one that adds a language.

State public accommodation laws

State laws reach practices whether or not they take federal money. Three examples:

New York. The Human Rights Law defines a place of public accommodation to include dispensaries, clinics and hospitals (N.Y. Exec. Law 292(9)). It is unlawful to deny a person the accommodations of such a place because of race, creed, color, national origin, citizenship or immigration status, sexual orientation, gender identity or expression, military status, sex, disability, marital status or status as a victim of domestic violence, or to publish an advertisement to the effect that the patronage of a person in one of the listed groups is unwelcome, objectionable or not solicited (N.Y. Exec. Law 296(2)(a)).
Washington. The law against discrimination covers any place where medical service or care is made available (RCW 49.60.040), and makes it an unfair practice to commit an act that directly or indirectly results in any distinction, restriction or discrimination (RCW 49.60.215(1)(a)).
California. The Unruh Civil Rights Act entitles all persons, whatever their sex, race, color, religion, ancestry, national origin, disability, medical condition, genetic information, marital status, sexual orientation, citizenship, primary language or immigration status, to full and equal accommodations, advantages, facilities, privileges or services in all business establishments (Cal. Civ. Code 51(b)).

Read the grounds closely. Age is not among the grounds listed in New York’s 296(2)(a) or California’s section 51(b), but it is a ground under Section 1557. Each state’s list, exceptions and remedies differ, and a practice in another state should check its own law.

What the platforms allow for health ads

Google’s policy on restricted targeting in personalized advertising lists health, clinical trial recruitment, birth control and sexual orientation, among others, as sensitive interest categories. Advertisers promoting products and services in those categories cannot use advertiser-curated audiences: customer match, your data segments, audience expansion and lookalike segments. Predefined Google audiences, which Google says are configured without sensitive user signals, remain available. The policy lists in-market and affinity segments, demographics, detailed demographics, life events and location targeting among them. Our guide to uploading patient lists to ad platforms covers the HIPAA side of customer match.

Meta’s November 2021 announcement named gender and age as broad targeting that advertisers could still use. Meta’s options change, so check the current settings in the account before you plan a campaign around one.

Practice job ads follow a separate rule. Google’s policy says demographics such as age, gender, marital status and parental status may not be used to target employment ads in the United States and Canada, and that ZIP code location targeting cannot be used for them either. See our guide to medical practice job ads.

Questions to ask before you narrow an audience

What is the clinical or practical reason for this setting, and is it written down?
Does the audience match a published recommendation, such as a screening age range, or a service the practice actually limits?
Is any group being excluded rather than included, and why?
Would the ad copy tell anyone outside the audience that they are not welcome?
Does the landing page serve anyone who arrives, including people outside the audience?
If the ad is in another language, can the phone line and the visit continue in that language?
Is this a job ad? If so, are demographic and ZIP code settings turned off?

Use and avoid

Use: age brackets that cover a screening recommendation, with the recommendation named on the landing page.
Use: ads in the languages your community speaks, with staff or interpreters ready for the calls they bring.
Use: a service area drawn by travel distance and the locations you serve.
Use: copy that says who a service is for, such as “care for women at each stage of life”.
Avoid: copy that says who is not welcome, such as “no men” or “English speakers only”.
Avoid: removing neighborhoods from a map because of who lives there.
Avoid: age, gender or ZIP code settings on job ads.
Avoid: customer match or lookalike audiences on health ads, which Google’s policy does not allow for sensitive categories.

An illustration

This example is invented. [Practice name], a primary care practice that bills Medicare Part B, plans a colorectal cancer screening campaign. The office manager sets Google’s age targeting to 45 to 54, 55 to 64 and 65 and up, and writes in the campaign notes that the brackets follow the Task Force recommendation for ages 45 to 75. The landing page says who the screening is for and that anyone can call to ask whether it fits them.

A second campaign promotes the practice’s new Spanish-speaking nurse practitioner. The ads are in Spanish, the landing page is in Spanish, and the phone tree offers Spanish. A colleague suggests trimming two ZIP codes from the radius to cut cost. The office manager asks why those two, hears that they have a lower response rate, checks that the reason is response data and not who lives there, and writes that reason in the campaign notes before making the change.

Checklist

Ask counsel whether your practice receives federal financial assistance and is covered by Section 1557.
Write down the reason for each age, sex, language and location setting.
Tie age targeting to a named clinical recommendation where one exists.
Do not look for race targeting, and do not use location settings as a stand-in for it.
Check ad copy and landing pages for wording that turns anyone away.
Confirm the phone line and intake can handle each language you advertise in.
Turn off demographic and ZIP code targeting on job ads.
Check your state’s public accommodation law for the grounds it lists.
Review targeting settings when a platform changes its options.

How we help

We build websites, local and organic search, Google Ads and lead generation and an AI front desk for independent practices. For ad targeting, that means campaigns with a written reason for each audience setting, service areas drawn by distance, and landing pages that serve anyone who arrives. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. For the wider rules, see our healthcare marketing rules guide.

Can we target a screening ad by age?

Aiming a screening ad at the ages in a published recommendation, such as the Task Force’s 45 to 75 for colorectal cancer screening, matches the purpose of the ad. The Age Act rules allow age distinctions in narrow cases (45 CFR 91.13, 91.14). Keep the service open to anyone who asks, and write down the reason for the setting.

Can we show a women’s health ad only to women?

Google’s demographic targeting offers gender, and its help page uses a women-only fitness studio as an example. Aim the ad where it is relevant, but keep the copy and the booking page free of wording that turns others away. New York’s law also covers advertisements that say a group is unwelcome (N.Y. Exec. Law 296(2)(a)).

Can we target ads by race or ethnicity?

Google lists race and ethnicity as a sensitive interest category, and Meta announced in 2021 that it would remove detailed targeting options relating to race or ethnicity. Title VI rules, carried into Section 1557, bar treating people differently on the ground of race, color or national origin (45 CFR 80.3). Do not use ZIP codes or radius settings as a stand-in.

Do we have to advertise in each language our patients speak?

We found no rule that requires it. Section 1557 requires covered practices to take reasonable steps to provide meaningful access to people with limited English proficiency (45 CFR 92.201), which applies when they contact you. Required disclosures in an ad go in the language of the ad (16 CFR 14.9).

Can we use customer match for health ads on Google?

Google’s personalized advertising policy says advertisers promoting products and services in sensitive interest categories, which include health, cannot use advertiser-curated audiences such as customer match. HIPAA also limits sending patient lists to an ad platform; see our guide to uploading patient lists to ad platforms.

Targeting healthcare ads by age, sex, race or language: what a practice can and cannot do