With the completion of the comprehensive poverty alleviation and the implementation of the rural revitalization strategy, significant changes have occurred in China's rural areas and agriculture. The population engaged in agriculture and living in rural areas has rapidly declined, posing significant challenges to the institutional structure and financing of medical insurance for urban and rural residents in China. This article attempts to provide policy insights for improving the medical insurance participation mechanism for urban and rural residents in China by reviewing the participation mechanism of German farmers and their medical insurance. Research has found that the financing of German farmers' medical insurance adopts a "one system, multiple levels" approach, and the amount of payment is based on the value of the farm land. Family members participating in insurance together will have their adult premiums halved and their children's premiums reduced by three-quarters, also they establish a premium refund mechanism and do not differentiate between medical categories regarding the payment of benefits. The proportion of government investment in farmers' medical insurance revenue has remained stable at over 50%. The German experience provides the following policy insights for China. Farmers' insurance premiums can be linked to their income. To incentivize participation in insurance, benefits can be added and the level of outpatient security can be appropriately improved. Based on the actual situation in China, it is necessary to consider the integration of employees’ medical insurance and urban and rural residents’ medical insurance in the future, and explore more flexible participation mechanisms.