Health insurance in Nigeria explained, for families abroad

The shape of the system

Nigeria has around 39,000 registered health facilities, 85% of them primary care; two thirds are government-run, one third private, and Lagos has more than any other state. About half of all care-seeking happens in the private sector. Roughly 72% of all health spending is paid out of pocket, a figure that has sat between 71% and 76% for years.

The National Health Insurance Authority Act of May 2022 made health insurance mandatory for everyone in Nigeria and created a fund to subsidise the poorest. Lagos State followed with an order in July 2024 making it mandatory for residents and employers. Enrolment has grown fast from a low base: 22 million people by July 2026, about a tenth of the population, against a government target of a fifth by 2027.

What an HMO is

An HMO (health maintenance organisation) is the company between the person and the hospital. It sells the plan, enrols the member, keeps a network of hospitals, issues the authorisation code a hospital needs before treating, and pays the hospital. The NHIA lists 94 accredited HMOs. Hospitals are paid a fixed amount per member for primary care and per item for referrals, which is why an HMO cares about how often you use it.

A plan comes with a card. At a network hospital the member shows the card, the hospital requests a code from the HMO, and treatment within the plan's limits is paid by the HMO. Since 1 April 2025 the HMO must issue the code within an hour; emergencies are treated first and coded within 48 hours.

What plans cost

Individual retail plans in Lagos in 2025 and 2026 ran from roughly N24,000 to N32,000 a year for the most basic (AXA Mansard EasyCare, Bastion Jade, Reliance Red Beryl), N45,000 to N65,000 for mid-range, and N100,000 to over N700,000 for the top tiers. The Lagos State scheme, Ilera Eko, was N15,000 a year for an individual in August 2026. Prices move with the naira; check the date on any figure.

The three things that matter more than the price

• Benefit limits. Every plan pays 'up to' an amount per year for each category: inpatient, outpatient, surgery, drugs. On the cheapest plans the inpatient limit can be N150,000, which one admission can exhaust. Top plans run to N3,000,000 or more.
• Waiting periods. Plans typically start 7 to 30 days after purchase for ordinary care, with 3 to 12 months before surgery, chronic disease management or maternity. Some exclude surgery entirely in the first year.
• Exclusions and pre-existing conditions. Treatment abroad, transplants, joint replacements and congenital conditions are commonly excluded. Pre-existing conditions are handled differently by each HMO: excluded, delayed or capped. Ask in writing.

What goes wrong

The NHIA's 2024 report recorded 3,507 complaints: against hospitals, mostly unavailable medicines, refused services and cash charges for covered items; against HMOs, delayed or refused codes and late payment to hospitals. It sanctioned 49 facilities and 47 HMOs. Separately, many Lagos hospitals still ask for a cash deposit of N50,000 to N200,000 before an emergency admission, HMO card or not.

What a relative abroad can buy

Several HMOs and brokers sell plans to the diaspora and take payment in pounds. The plan is in the relative's name and used by them in Nigeria. What no HMO plan includes is a person: someone who goes to the house, sits in the consultation, and tells you what was said. That is the gap a Kinship Plan is built for. Kinship Well provides health benefits in the member's name through the Care Partner's arrangement with a licensed provider, and Kinship Visits and the Kinkeeper add the person.

Questions people ask

Related

• HMOs in Nigeria explained
• The health benefits in Kinship Well