BACKGROUND Medicinal plants play an essential role in primary healthcare practices in Indonesia, particularly in rural areas. While medicinal plants are broadly used in Indonesia, the country has made a commitment to healthcare services based on modern medicine through the provision of universal health coverage (UHC). OBJECTIVE In the context of the UHC system in Indonesia, we explore the utilization of medicinal plants in rural West Java by examining how herbal medicine use varies with socio-economic and demographic factors and whether herbal medicine use remains important when modern healthcare becomes available. METHODS A total of 634 households in the two rural communities were randomly selected to participate in the survey. A semi-structured questionnaire was administered to a randomly selected adult in each household. RESULTS Herbal medicine use prevalence was found to be 68% (431/634). Out of 549 total respondents with perceived illness, 40% (219/549) self-medicated with herbal medicines in the last six months. A total of 102 medicinal plant species belonging to 43 families were reported, each with their local names, medicinal use, and parts used. We found that herbal medicine use was significantly associated with the area of residence, age, education level and occupation, and was not correlated to gender or health insurance possession. CONCLUSIONS Medicinal plant remains a significant aspect of healthcare for rural communities in the West Java area. The presence of healthcare services under the UHC system is not a critical determining factor for treatment-seeking and may have less impact on the pervasive practice of herbal medicine use in rural areas.