diff --git a/octodns/provider/route53.py b/octodns/provider/route53.py
index ee9d05d..85d35e6 100644
--- a/octodns/provider/route53.py
+++ b/octodns/provider/route53.py
@@ -500,6 +500,10 @@ class Route53Provider(BaseProvider):
         # use
         expected_re = re.compile(r'^\d\d\d\d:{}:{}:'
                                  .format(record._type, record.name))
+        # Until the v1.0 release we'll clean out the previous version of
+        # Route53 health checks as best as we can.
+        expected_legacy_host = record.fqdn[:-1]
+        expected_legacy = '0000:{}:'.format(record._type)
         for id, health_check in self.health_checks.items():
             ref = health_check['CallerReference']
             if expected_re.match(ref) and id not in in_use:
@@ -507,6 +511,12 @@ class Route53Provider(BaseProvider):
                 # planning to use going forward
                 self.log.info('_gc_health_checks:   deleting id=%s', id)
                 self._conn.delete_health_check(HealthCheckId=id)
+            elif ref.startswith(expected_legacy):
+                config = health_check['HealthCheckConfig']
+                if expected_legacy_host == config['FullyQualifiedDomainName']:
+                    self.log.info('_gc_health_checks:   deleting legacy id=%s',
+                                  id)
+                    self._conn.delete_health_check(HealthCheckId=id)
 
     def _gen_records(self, record, creating=False):
         '''
diff --git a/tests/test_octodns_provider_route53.py b/tests/test_octodns_provider_route53.py
index 7ec0d34..5d34f50 100644
--- a/tests/test_octodns_provider_route53.py
+++ b/tests/test_octodns_provider_route53.py
@@ -18,6 +18,12 @@ from octodns.zone import Zone
 from helpers import GeoProvider
 
 
+class DummyR53Record(object):
+
+    def __init__(self, health_check_id):
+        self.health_check_id = health_check_id
+
+
 class TestOctalReplace(TestCase):
 
     def test_basic(self):
@@ -807,18 +813,13 @@ class TestRoute53Provider(TestCase):
             }
         })
 
-        class DummyRecord(object):
-
-            def __init__(self, health_check_id):
-                self.health_check_id = health_check_id
-
         # gc no longer in_use records (directly)
         stubber.add_response('delete_health_check', {}, {
             'HealthCheckId': '44',
         })
         provider._gc_health_checks(record, [
-            DummyRecord('42'),
-            DummyRecord('43'),
+            DummyR53Record('42'),
+            DummyR53Record('43'),
         ])
         stubber.assert_no_pending_responses()
 
@@ -866,6 +867,71 @@ class TestRoute53Provider(TestCase):
         provider._gc_health_checks(record, [])
         stubber.assert_no_pending_responses()
 
+    def test_legacy_health_check_gc(self):
+        provider, stubber = self._get_stubbed_provider()
+
+        old_caller_ref = '0000:A:3333'
+        health_checks = [{
+            'Id': '42',
+            'CallerReference': self.caller_ref,
+            'HealthCheckConfig': {
+                'Type': 'HTTPS',
+                'FullyQualifiedDomainName': 'unit.tests',
+                'IPAddress': '4.2.3.4',
+                'ResourcePath': '/_dns',
+            },
+            'HealthCheckVersion': 2,
+        }, {
+            'Id': '43',
+            'CallerReference': old_caller_ref,
+            'HealthCheckConfig': {
+                'Type': 'HTTPS',
+                'FullyQualifiedDomainName': 'unit.tests',
+                'IPAddress': '4.2.3.4',
+                'ResourcePath': '/_dns',
+            },
+            'HealthCheckVersion': 2,
+        }, {
+            'Id': '44',
+            'CallerReference': old_caller_ref,
+            'HealthCheckConfig': {
+                'Type': 'HTTPS',
+                'FullyQualifiedDomainName': 'other.unit.tests',
+                'IPAddress': '4.2.3.4',
+                'ResourcePath': '/_dns',
+            },
+            'HealthCheckVersion': 2,
+        }]
+
+        stubber.add_response('list_health_checks', {
+            'HealthChecks': health_checks,
+            'IsTruncated': False,
+            'MaxItems': '100',
+            'Marker': '',
+        })
+
+        # No changes to the record itself
+        record = Record.new(self.expected, '', {
+            'ttl': 61,
+            'type': 'A',
+            'values': ['2.2.3.4', '3.2.3.4'],
+            'geo': {
+                'AF': ['4.2.3.4'],
+                'NA-US': ['5.2.3.4', '6.2.3.4'],
+                'NA-US-CA': ['7.2.3.4']
+            }
+        })
+
+        # Expect to delete the legacy hc for our record, but not touch the new
+        # one or the other legacy record
+        stubber.add_response('delete_health_check', {}, {
+            'HealthCheckId': '43',
+        })
+
+        provider._gc_health_checks(record, [
+            DummyR53Record('42'),
+        ])
+
     def test_no_extra_changes(self):
         provider, stubber = self._get_stubbed_provider()