In this paper, we develop an expected utility maximization model for Chinese rural residents who make their health care and health insurance decisions in two stages, choosing among no insurance, the New Rural Cooperative Medical System (NRCMS), and a commercial health insurance. It is found that although not everyone benefits from the NRCMS, it does improve the welfare of a large number of rural residents and help them seek a higher level of medical care service. The results suggest that additional aid to the extremely poor is still needed during catastrophic medical loss, and detailed provisions that can differentiate the support level to rural residents based on income are needed. It is also found that commercial health insurance can still play a role in protecting rural residents from financial losses caused by health risks.