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Even though a major objective of the Ghana National Health Insurance Scheme at its promulgation in 2003 was a universal subscription by 2008, the scheme covered 38.3 per cent of the Ghanaian population by 2014. We examined trends in health insurance subscription at Cape Coast from 2005 to 2014. The study was conducted with data from the National Health Insurance Scheme from 2005 to 2014. A record review approach was adopted in extracting records of insurance subscription within the period under review. Data collected were presented using percentages and chi-square statistics. Subscription to the scheme declined from 43.9 per cent in 2005 to 40.6 per cent in 2014. There were more female than male subscribers in all the years under review. Subscription increased for persons under 18 years and those in the informal sector over the ten-year period, but declined for Social Security and National Insurance Trust contributors and pensioners, the aged, indigents, and pregnant women. The study underscores the need for the National Health Insurance Authority to increase subscription to the scheme through innovative ways such as sharing the scheme’s achievements through improved advertisement and contracting private entities through public-private partnerships to augment its efforts at recruiting more subscribers.