Accurately identifying and effectively managing the risks involved in the implementation of the medical insurance benefits list system is a key component in ensuring its smooth and successful implementation and effectiveness. The study finds that among the policy adjustments involved in the medical insurance benefits list system, four are high-risk and eleven are moderate-risk. Factors contributing to these risks include loss of interests, unscientific and unjust decision-making, implementation deviations, policy gaps, differences in risk perception, and timing of reforms. It is recommended that each coordinating region, in the process of implementing the medical insurance benefits list system, should focus on actively preventing risks, improving the risk-bearing mechanism, strengthening scientific and democratic decision-making, enhancing policy communication, perfecting incentive and restraint mechanisms, accelerating the development of medical insurance, and deepening comprehensive medical insurance reform.