OBJECTIVES: This study investigates the perceptions of Saudi students attending American universities towards a new Mandatory Cooperative Health Insurance Program (MCHIP) that was introduced recently in Saudi Arabia. METHODS: This was a cross-sectional study. Data were collected using e-survey method including all 2210 Saudi students based on a list provided by the Saudi Cultural Mission at USA. Likert scale was employed to measure the students’ expectations of the MCHIP with respect to cost, quality, and access of health care; (1= strongly agree to 5= strongly disagree). Logistic regression was used to measure the effects of knowledge (knowledge of the MCHIP, knowledge of the American health system, and total knowledge of health insurance) and students’ expectations of the MCHIP regarding cost, quality and access. The response variable was categorized as binary; high knowledge 91), while low knowledge (0). Validity and reliability were done. RESULTS: Survey response rate was 40.6%. A total of 55.6% agree that cost will be increased while 19.4% disagree with mean score of 2.45 (SD=1.13). A total 65.3% agree that quality is going to be improved, while 8.3% disagree with mean score of 2.5 (SD= 0.99); 56.3% agree that access will be improved, while 15.7% disagree with mean score 2.45 (SD =1.04). Odds ratio of high knowledge compared to low knowledge was 2.91(P-Value = 0.001) for cost, 1.61. (P-Value=0.461) for quality, and 2.64 (P-Value = 0.203) for access. CONCLUSIONS: Majority expected MCHIP implementation will increase total costs, improve quality, and increase access to health care in Saudi Arabia. Total knowledge of health insurance had a significant effect on students’ perceptions of cost and a non-significant effect on their perceptions of quality and access to health care. To promote success, the MCHIP should provide affordable and accessible quality health care to the population, based on developed regulations. Awareness campaign should be launched.