Low enrollment intention threatens the funding pools of rural insurance schemes in developing countries. The purpose of this study is to investigate how social capital enhances the enrollment of health insurance among rural middle-aged and elderly. We propose that social capital directly increases health insurance enrollment, while indirectly influences health insurance through health risk avoidance. We used data from the China Health and Retirement Longitudinal Study (wave 4) dating the year of 2018, instrumental variable estimation was introduced to deal with the endogeneity problem, and the mediation analysis was used to examine the mechanism of social capital on insurance enrollment. The results show that social capital is positively related to social health insurance enrollment, and the relationship between social capital and social health insurance enrollment is mediated by health risk avoidance.

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