Background Weather-related risks thwart agricultural productivity gains especially in the face of climate change. Agricultural insurance serves as a reliable risk mitigation instrument for coping with climate-related hazards. This notwithstanding, agricultural insurance penetration among smallholder farmers in the global south remains low. This study investigated the access and acceptability of agricultural insurance among smallholder food crop farmers in Ghana. Method The study employed a mixed-methods approach involving both quantitative and qualitative approaches. The study was carried out in the Northern, Volta and Western regions involving 7 communities in 5 districts. A total of 200 farmers were sampled through a multi-stage purposive sampling and interviewed. A cross-sectional survey involved 100 respondents under the quantitative approach whilst the qualitative study engaged additional 100 farmers. Results The results show that smallholder farmers’ access and acceptability of agricultural insurance is low (14%) and scarce but ironically considered useful by many (90%) as an effective tool to deal with agricultural risks. Inadequate knowledge about agricultural insurance products constituted the most stated reason (64%) for the scarce adoption rate, followed (23%) by the unavailability of insurance products in areas needed but absent. A few (5%) reported insurance to be expensive. Acceptability and accessibility of agricultural insurance are further influenced by gender, educational level, low knowledge, information asymmetry and wrong perception concerning agricultural insurance products. Sense of security and reduced impact of climate variabilities constituted important benefits guaranteed by agricultural insurance. Conclusions Agricultural insurance access and acceptability is constrained by limited knowledge of agricultural insurance products. It is recommended that more insurance companies be incentivized to augment already existing efforts by Ghana Agricultural Insurance Pool (GAIP) to enroll more smallholder farmers. The government can consider bundling existing insurance products with credit or inputs under the Planting for Food and Jobs Programme (PFJ) to improve uptake and accessibility of agricultural insurance.