This Note details the ways low income families in India deal with their medical exigencies in the absence of quality public heath care facilities – through a variety of savings, loans and distress sales. Thus medical emergencies create very difficult situations for the poor, depleting their resources – financial, social and physical. Health insurance programmes may provide an opportunity to help the poor manage health risks. However, the idea of health insurance is new to the low income population. Reasons like inappropriate products, lack of insurance awareness, limited trust in the insurance agents, previous experiences of fraud, or lack of trust in insurance companies add to the poor penetration of such schemes.