Since the 1990s, community-based health insurance (CBHI) schemes have been proposed to reduce the financial consequences of illness and enhance access to healthcare in developing countries. Convincing evidence on the ability of such schemes to meet their objectives is scarce. This paper uses randomized control trials conducted in rural Uttar Pradesh and Bihar (India) to evaluate the effects of three CBHI schemes on healthcare utilization and expenditure. We find that the schemes have no effect on these outcomes. The results suggest that CBHI schemes of the type examined in this paper are unlikely to have a substantial impact on access and financial protection in developing countries. Copyright © 2015 John Wiley & Sons, Ltd.