OBJECTIVES: Access to health care for indigent population in Ghana remains a challenge despite introduction of the National Health Insurance Scheme (NHIS) in 2004 to address the problem of financial barriers to health care access. The situation is worse in rural settlements where there are inadequate or no health care facility and health care professionals. The Ada Kofe community is a fishing community in the Tema Metropolis with most of the inhabitants fully engaged in fishing as their source of livelihood. The community has no primary health care facility and as result inhabitants face geographical and financial difficulties when accessing health care. The study aimed to explore access to health care services in Ada Kofe community. METHODS: Face-to-face interview method was employed to collect data on health insurance cover, usual source of care, and other barriers to health care access in the community using semi-structured questionnaire. RESULTS: About 45% of the respondents had health insurance cover. Although most households had usual place of ongoing care, 56.7% specifically used hospital OPD outside the community for their health care needs. This creates financial and geographical difficulties which in extreme cases may lead to avoidable deaths. About one-third of the respondents faced financial, structural, and personal barriers when accessing health care in the community due to lack of health care facilities and health insurance cover. CONCLUSIONS: More than half of the households in the community do not have health insurance cover. Moreover, the community has no primary health care center and as a result household members travel outside the community to access health care. An establishment of NHIS registration centre in the community will increase enrolment and facilitate access to health care. Provision of community health centre will also help remove some of the financial barriers households faced when accessing care.