Objective: The paper attempts to investigate the necessity awareness of continuous enrollment in Urban and Rural Residents’ Basic Medical Insurance (URRBMI) among insured residents in Xuzhou and to explore its influencing factors, so as to provide evidence for improving the long-term enrollment mechanism of URRBMI. Methods: A multistage stratified random cluster sampling method was used to select residents enrolled in URRBMI in Xuzhou for a questionnaire survey. Descriptive analysis was conducted to examine their necessity awareness of continuous enrollment. Chi-square tests were used for univariate analysis of the influencing factors, and a decision tree model was constructed for multivariate analysis. Results: A total of 624 residents enrolled in URRBMI were surveyed, among whom 557 (89.3%) considered it necessary to continue participating in URRBMI, while 67 (10.7%) considered it unnecessary. Univariate analysis showed that gender, age, presence of chronic disease, participation in commercial insurance, satisfaction with the contribution amount, and satisfaction with the reimbursement amount were associated with the necessity awareness of continuous enrollment (P < 0.05). Decision tree analysis indicated that the influencing factors, in descending order of importance, were age, satisfaction with the reimbursement amount, presence of chronic disease, satisfaction with the contribution amount, and gender. Conclusions: Insured residents enrolled in URRBMI in Xuzhou generally demonstrated a high level of necessity awareness for continuous enrollment, although marked differences were observed across population groups. Greater attention should be paid to younger individuals, those in relatively good health, and those with a weaker sense of institutional benefit. Efforts should focus on optimizing policy publicity, improving contribution and benefit mechanisms, and enhancing residents’ perceived benefit from the system, so as to strengthen enrollment stability in URRBMI.