Partnerships play a central role in later-life health, with partners serving as primary sources of informal care. Yet population-level estimates of disability patterning within couples remain largely absent for same-sex couples, leaving their potential care needs and circumstances poorly understood. Using American Community Survey data on couples in which both partners are aged 50 and older and drawing on a couple-level minority stress framework, we examine disability prevalence across the cognitive, independent living, self-care, and vision or hearing domains by couple sex composition. Compared to male-female couples, both male-male and female-female couples are more likely to have both partners experiencing difficulty across nearly all domains after sociodemographic adjustment. Female-female couples show the most consistent and pronounced pattern across all four domains, while male-male couples exhibit a similar but attenuated pattern. Within same-sex couples, female-female couples are more likely than male-male couples to have both partners experiencing difficulty in the cognitive and independent living domains, with more limited differences in self-care and no differences in vision or hearing. Notably, roughly 1 in 10 couples across all groups have both partners experiencing at least one difficulty — a circumstance that increases the likelihood of needing external support. This may be especially consequential for same-sex couples, whose support networks tend to center chosen family rather than the intergenerational bio-legal kin that different-sex couples more commonly draw on. Bio-legal kin are not only more likely to receive institutional recognition but are also less likely to be navigating their own aging health challenges. Together, these findings underscore the value of couple-level disability indicators and the importance of policies that recognize diverse caregiving arrangements in later life.