This study investigates the key factors influencing undergraduate students’ intention to purchase medical health insurance (MHI) in Malaysia, a context where health insurance uptake remains modest despite rising healthcare costs and a growing private sector. Grounded in the Theory of Planned Behaviour (TPB), Health Belief Model (HBM), and Protection Motivation Theory (PMT), the research evaluates how knowledge, social influence, financial literacy, and product attributes shape students’ intentions toward health insurance acquisition. A cross-sectional survey was conducted among 109 final-year undergraduate students across six academic schools at a Malaysian university using stratified sampling. The results revealed that students generally hold a moderate to high intention to purchase MHI, particularly in the context of long-term financial planning. However, immediate intent to act remains low. Multiple regression analysis identified knowledge, product attributes, and social influence as significant predictors of intention. Financial literacy also played a critical role in shaping students' perception of health insurance benefits and necessity. Interestingly, neither gender nor academic background significantly influenced insurance intention. These findings suggest a need for targeted education and policy strategies to improve insurance literacy and design student-friendly insurance products. The study contributes to the broader understanding of youth insurance behaviour and offers actionable insights for insurers, universities, and policymakers aiming to boost MHI uptake among young adults.