In order to promote the construction of Internet-based medical insurance payment to better meet the diverse reimbursement needs of residents, this study systematically summarizes the inherent opportunities and potential challenges of medical insurance payment in the context of "Internet plus healthcare". By analyzing the current situation of medical insurance payment in the era of the Internet, the continuous infusion of new momentum into the construction of the Internet-based medical insurance payment system has been driven by the development of Internet healthcare and the growing demand of the public. However, there are also challenges such as lagging policies and regulations, increased fund risks during the initial stages of construction. Based on the analysis above, it is suggested to improve policies and regulations in conjunction with reality, strengthen online fund management from multiple dimensions, introduce new technologies to ensure the orderly operation of the Internet-based medical insurance system while safeguarding patients’ privacy, and meet the diverse needs of the public to build a fair, orderly, efficient, convenient, inclusive, and sustainable online medical insurance payment system.