Medina Lake offers multiple boat ramp access points for recreational boating and fishing.

Key options include Joe's Place Marina (two cement ramps, $8 launch fee, with restrooms, courtesy dock, camping, RV sites, handicap access, and boat gas), Red Cove Cafe & Marina (two-lane concrete ramp near Medina Dam, $20 launch fee, usable at lake levels 30 feet and above), Park Road 37 (concrete ramp in Plum Creek Cove, open 24 hours with parking and restrooms), and Pop's Place (two-lane concrete ramp between Pipe Creek and Lakehills with camping and cleaning station).

All ramps provide parking and basic amenities, though water level conditions may affect usability at some locations.