Objective：To understand the degree of awareness of the implementation of the major illness insurance system for urban and rural residents in the residents of Jiangyin and Taicang，and to provide evidence for the improvement of the serious illness insurance system and promote the allocation of public resources. Methods：The method of questionnaire survey was used to analyze the awareness and willingness of participation of the insured people in Jiangyin and Taicang，Jiangsu Province based on one-way analysis of variance and binary logistic regression. As a result，Taicang residents are more willing to continue to participate in health insurance than Jiangyin. Jiangyin residents’ willingness to participate in serious medical insurance is not strong；Jiangyin residents are relatively ignorant of the content of the policy；both residents hope to extract part of the basic medical insurance fund. The fund went out to pay for major illness insurance without additional burden of payment；Compared with Jiangyin residents，Taicang residents were more satisfied with the policy of serious illness insurance reimbursement for urban and rural residents. The significant factors affecting the insured people’s willingness to participate in major illness insurance include the type of household registration，whether to participate in the medical insurance for diseases，and the degree of understanding of the contents of the medical insurance policy for major diseases. Conclusion Strengthen policy publicity and improve the construction of serious illness insurance system for urban and rural residents. Change the traditional ideology.