Background The impact of safety‐net status, case volume, and outcomes among geriatric head and neck cancer patients is unknown. Methods Chi‐square tests and Student's t tests to compare head and neck surgery outcomes of elderly patients between safety‐net and non‐safety‐net hospitals. Multivariable linear regressions to determine predictors of outcome variables including mortality index, ICU stays, 30‐day readmission, total direct cost, and direct cost index. Results Compared with non‐safety‐net hospitals, safety‐net hospitals had a higher average mortality index (1.04 vs. 0.32, p = 0.001), higher mortality rate (1% vs. 0.5%, p = 0.002), and higher direct cost index (p = 0.001). A multivariable model of mortality index found the interaction between safety‐net status and medium case volume was predictive of higher mortality index (p = 0.006). Conclusion Safety‐net status is correlated with higher mortality index and cost in geriatric head and neck cancer patients. The interaction between medium volume and safety‐net status is independently predictive of higher mortality index.