While there is a body of research on the gendered penalties of user fees within health systems in low-income countries, what is less well understood is the gendered experience of community-based health insurance (CBI) programs, which have replaced user fees for basic healthcare. This study examines the uptake of a Rwandan CBI scheme five years after the program was scaled up nationwide. Using the Enquete Intégrale sur les Conditions de Vie des ménages de Rwanda (EICV2) for 2005–6, the study finds evidence that members of female-headed households are less likely than those of male-headed households to be enrolled in the CBI program. Additionally, it finds strikingly different patterns of equity effects of CBI by gender of household head by examining consumption income and wealth. These findings suggest the need for greater attention to equity, particularly gender equity, concerning the way in which voluntary CBI programs are initially implemented and evaluated.