Verbal communication between patients and healthcare providers is an important piece of successful healthcare delivery. Less familiar medical terminology coupled with noisy hospital environments can lead to speech intelligibility challenges between healthcare providers and patients. Prior results showed lower word recognition accuracy for lower familiarity and frequency words and in the presence of noise in younger adults (Bent et al., 2022). The current study expands on the previous work with the inclusion of older adults and an additional noise masking condition. Online listening tests were conducted to study the impacts of word familiarity and background noise on speech perception in younger (age 18–35) and older adults (age 60–85). Participants were presented with a corpus of 160 medically related sentences with varying word familiarity and frequency characteristics, and word recognition accuracy was recorded. Sentences were presented in quiet, hospital noise, speech-shaped noise, and speech-shaped noise modulated by the hospital noise envelope, a novel condition from previous work. Results highlight a comparison of speech recognition performance between the two age groups. Effects of sentence familiarity/frequency rating and type of noise masker on speech intelligibility are discussed. [Work supported by the James S. McDonnell Foundation https://doi.org/10.37717/2021-3028.]