This study examines the impact of health insurance on Senegalese rural populations in Mozambique, focusing on cost sharing behaviour and changes in service utilization. Data from a cross-sectional study involving interviews with 500 randomly selected households in rural areas was analysed using logistic regression models to assess the relationship between health insurance coverage and service utilization changes, while accounting for potential confounders such as income level and education. The analysis revealed that individuals covered by health insurance were more likely to use preventive services (odds ratio = 1.52, p < 0.001), suggesting a significant increase in service utilization. Health insurance programmes appear effective in promoting the uptake of preventive healthcare among rural Senegalese populations in Mozambique. Policy makers should consider expanding health insurance coverage to further enhance access and usage of preventive services by rural residents.