A comprehensive study of the Ce addition effect on microstructure, inclusions, and primary carbides in H13 steel was carried out. 3D morphology of inclusions and primary carbides was assessed by the non-aqueous electrolytic method. The addition of 0.0038 mass% Ce had no obvious refinement effect on dendritic structures in H13 steel. With Ce content increase from 0.0038 to 0.019 mass%, dendritic structures of H13 steel were refined. Al2O3 and MnS inclusions in original H13 steel promoted heterogeneous nucleation of primary carbides. Al content increased, and S content decreased with increasing Ce content. When the latter was increased from 0.0038 to 0.019 mass%, the original inclusions were modified first to Al11O18Ce and CeAlO3, then to Ce2O3, and, finally, to Ce2O2S. Numerous small-sized Ce2O2S inclusions were found in steel with 0.019 mass% Ce, which promoted nucleation of γ-Fe during solidification and contributed to the refinement of as-cast dendritic microstructures of H13 steel. Besides, Ce2O2S inclusions suppressed heterogeneous nucleation of primary carbides. The size of primary carbides decreased, and their morphology became less developed due to the finer microstructure hindering their growth. Finally, banded structures in forged Ce-bearing H13 steel were improved.