Nigeria’s health insurance market has crossed the 22 million enrollee mark, signalling accelerating coverage growth, but millions of Nigerians remain outside the insurance system and vulnerable to rising out-of-pocket healthcare costs.
The National Health Insurance Authority said enrolment reached 22.03 million by July 2026, representing a 35 per cent increase from a year earlier as efforts to implement mandatory health insurance under the NHIA Act gather pace.
The latest growth has been driven significantly by state-backed social health insurance programmes, which are increasingly becoming an important channel for expanding coverage beyond the formal sector.
Data contained in the NHIA’s fourth-quarter 2025 dashboard showed that state schemes accounted for 9.74 million beneficiaries, compared with 7.07 million under programmes managed directly by the NHIA.
Despite the expansion, the level of coverage remains modest compared with Nigeria’s overall population, leaving a substantial number of citizens without financial protection against healthcare expenses.
The coverage gap is particularly significant among low-income households and workers in the informal economy, many of whom have irregular earnings and continue to pay directly for medical services when they need care.
For insurers and health maintenance organisations, the challenge is therefore shifting from simply attracting customers to developing products and payment systems that reflect the financial realities of a largely informal workforce.
Affordability remains a major hurdle
Industry stakeholders say the slow expansion of health insurance cannot simply be attributed to a lack of interest among Nigerians.
The Managing Director and Chief Executive Officer of SUNU Health Nigeria Limited, Dr Moyosore Olomola, said structural barriers were playing a larger role in limiting enrolment.
According to Olomola, consumers are more willing to purchase and retain health insurance when products are affordable, accessible and supported by reliable claims settlement.
“The obstacles are structural, not attitudinal, and I want to push back on the narrative that Nigerians simply do not value health insurance,” he said.
He added that the experience of his organisation showed that customers would enrol and renew when insurance products were accessible and affordable and claims were settled promptly.
Olomola identified income volatility as one of the biggest barriers to expanding coverage, particularly given the large proportion of Nigerian workers whose earnings are irregular, seasonal or cash-based.
He argued that conventional premium structures requiring monthly or annual upfront payments may not adequately reflect the financial circumstances of such workers.
State schemes emerge as growth engine
The growing contribution of state social health insurance agencies points to the increasing importance of sub-national programmes in Nigeria’s drive towards broader health coverage.
Under the NHIA framework, state schemes are expected to establish equity funds designed to extend insurance protection to poor and vulnerable residents.
The NHIA Act, enacted in 2022, replaced the former National Health Insurance Scheme and created a broader framework for achieving health insurance coverage among Nigerians and legal residents.
The authority operates programmes covering formal-sector workers, organised private-sector employees and vulnerable groups, while state schemes provide additional coverage at the local level.
However, expanding the number of registered beneficiaries does not automatically translate into effective financial protection.
The quality and accessibility of healthcare providers, affordability of premiums, claims experience and public confidence in insurers and healthcare providers all influence whether enrolment translates into sustained coverage.
Insurers call for industry reforms
Olomola said addressing the coverage gap would require more flexible approaches to premium collection, particularly for workers outside the formal economy.
He also called for increased investment in healthcare provider networks in underserved states and stronger accountability mechanisms for HMOs and healthcare providers.
Such measures, he argued, would make health insurance more responsive to consumers while strengthening confidence in the system.
The stakes are significant as heavy reliance on out-of-pocket payments can leave households financially vulnerable when serious or recurring medical needs arise.
For Nigeria’s insurance industry, the rise to more than 22 million enrollees represents meaningful progress, but the much larger population still outside the system means the next phase of market development will depend on making health insurance affordable, flexible and trusted.
With state schemes emerging as major drivers of enrolment, the ability of regulators, insurers, HMOs and healthcare providers to address affordability and service-delivery challenges will be critical to converting Nigeria’s expanding enrolment figures into broader and more sustainable health protection.
