It has been observed that health shocks decreases the productivity and potential investments into agriculture, and as such further perpetuates poverty among smallholder farmers. It is argued that, health insurance coverage for smallholder farmers can go a long way to ameliorate the impact of heath shocks and smoothen agricultural investments. However, very little is known about the impact that health insurance coverage has on smallholder farmers’ land-related investment. Thus, this study using enrolment information on the Ghana National Health Insurance Scheme (NHIS) examines the determinants of health insurance coverage amongst smallholder farmers and goes further to examine the impact of coverage on agricultural investments in the form of the level of agricultural inputs used in production and also the level of hired labour employed. The study employed a number of estimation approaches to address issues relating to endogeneity – the fact that NHIS coverage is nonrandom or in other words NHIS is not randomly assigned. To address this issue and estimate causal impact of NHIS, propensity score matching (PSM) estimations and two-stage stage residual inclusion model were estimated to augment the Ordinary Least Squares (OLS) estimator. The result shows that, household head characteristics such as gender, age and educational level, as well as farm size and household expenditure influences the enrollment in NHIS amongst smallholder farmers. In term of impact, estimates from propensity score matching and the two-stage residual inclusion reveals a positive and significant effect of NHIS on agricultural input used and improved hired labour use on smallholder farms.