Insurance participation and payment is the first step in medical insurance, and the foundation of high-quality development of healthcare security in the new era. Ensuring full coverage and paying full contributions are important responsibilities of medical insurance agencies. Participating in insurance includes the registration of basic information and changes in information. Only by paying the fees in full in accordance with the law can a medical insurance relationship be established. This study investigates and analyzes the current insurance payment models, specific implementation process, and representative practice in various regions in China. It is believed that they are no longer suitable for the development requirements of the new era, manifested in unclear responsibilities for insurance payment among departments, lack of unified national standards and norms, and inability to timely share relevant information between payment agencies and medical insurance agencies. Participants are in arrears, underpayment, interruption of insurance participation and payment, repeated participation in insurance and payment, as well as the lack of a reasonable and effective mechanism for historical legacy issues in payment. It is suggested reforming the process of registration, reviewing materials, verifying payment and paying fees, and merging them into "payment means participating in insurance" and "handling each matter once", Independent declaration and payment by legal persons and individuals, and independently modify insurance information based on personal information changes should be fully implemented. Meanwhile, we should establish an insurance payment mechanism for the convenience of insured units and residents, improve the audit and verification mechanism of medical insurance and tax departments, ensure accurate declaration information and truthful payment fees of insured subjects, and achieve the goals of full coverage and paying full contributions.