Many households in Ghana are exposed to risks from preventable diseases, poor weather, and economic mismanagement but they have limited access to quality health care because of existing ineffective financing options, especially for the poor and people who live in rural areas. This study uses data from the two oldest community-based health insurance schemes in Ghana to investigate the role of this type of schemes on access to health care and health care expenditures. It also examined how the schemes cover the people who need the advantages of insurance most; poor people and high risk individuals, who would find it difficult to pay for health care in the absence of insurance. The findings reveal strong positive effects on access to quality health care but portray remarkable exclusion of the poorest of the poor. The study highlights the need for improved rural health infrastructure and stronger linkages between modern and traditional means of risk sharing to make the newly introduced national health insurance scheme in Ghana more effective and equitable.