Community-based health insurance (CBHI) is a kind of health insurance targeted at low-income groups and it has the potential to provide financial risk protection against exorbitant medical expenses among them. In Rwanda, CBHI is being implemented across the country but low adherence to the CBHI still persist. In this peer reviewed study, the authors assessed the determinants of low adherence to the CBHI in rural Nyanza district, southern Rwanda. The findings show that long waiting time to see a medical care provider and unaffordable premiums are some of the factors behind to this low adherence.