Socioeconomic development in Malaysia, over the past few decades, has led to the improvement and expansion of the public healthcare system. This system has provided universal access to a low-priced package of comprehensive health care leading Malaysia to claim to have achieved universal health coverage (UHC). However, the Malaysian health landscape is changing rapidly. Provision of private care has grown especially in large urban towns, mainly in response to public demand. Thus far, private care has been predominantly bought and utilised by the rich but because of differentials in quality of care between the public and private sector, unabated expansion of the private health sector has the potential to adversely affect universal access to care. This effect may be accentuated in the coming years by demographic changes in the country specifically by the ageing of the population. This paper is intended to highlight challenges to UHC in Malaysia in the face of the changing health landscape in the country and to offer some suggestions as to how these challenges can be met.