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Nigeria’s health insurance sector remains one of the most under-penetrated in Africa, with coverage still below 10% of the country’s over 220 million population as of December 2025.
Despite legal provisions making health coverage mandatory for all citizens and legal residents, out-of-pocket spending continues to dominate healthcare financing across the country.
Data from the National Health Insurance Authority, NHIA, shows that only 21.73 million residents were enrolled under various health insurance schemes across the 36 states and the FCT at the end of Q4 2025.
Delta State recorded the highest enrolment, while Taraba State had the lowest with 213,935 enrollees.
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The top two states, Delta and Lagos, accounted for a combined 5.68 million enrollees, representing 26.14% of total national coverage.
As government and state agencies intensify reforms to achieve universal health coverage, the gap between high-performing and low-performing states remains wide.
Here are the 10 states with the largest health insurance coverage as at Q4 2025.
10. Jigawa – 583,766 Enrollees
Jigawa rounded out the top 10 with 583,766 enrollees. The State Social Health Insurance Agency, SSHIA programme had 369,233 enrollees, while the BHCPF programme covered 104,029. The federal formal sector recorded 62,267 enrollees.
Private HMO enrolment was the lowest among the top 10 at 5,952, reflecting limited private sector penetration. The BHCPF number is among the highest in the top 10, showing the importance of the fund in the state.
Jigawa’s data reinforces a pattern seen in several northern states: scale is being driven by SSHIA and BHCPF rather than private insurance. Closing the gap will require stronger state programmes and better HMO market development.
9. Katsina – 603,238 Enrollees
Katsina State recorded 603,238 enrollees at the end of Q4 2025. The SSHIA programme covered 294,640 residents, while Community-Based Health Insurance, CBHI, accounted for 93,986. The federal formal sector had 91,808 enrollees.
Private HMO enrolment was minimal at 7,865, indicating that the market is still nascent. The CBHI figure is notable, as community-based models are often critical in rural northern states.
Katsina’s mix shows a reliance on SSHIA, CBHI, and federal schemes. Growing the CBHI model and improving affordability could be key to moving Katsina above the 600,000 mark.
8. Ekiti – 629,873 Enrollees
Ekiti ranked eighth with 629,873 enrollees as of December 2025. The SSHIA programme dominated with 347,927 enrollees, or 55.23% of the state’s total coverage. Tertiary Institutions Social Health Insurance Programme, TISHIP covered 96,676 residents, while the federal formal sector had 70,660.
Ekiti’s relatively high TISHIP number, second only to Oyo among the top 10, points to the influence of its universities and polytechnics. The state’s SSHIA performance also shows steady progress in state-led enrolment.
With over half of its coverage from SSHIA, Ekiti mirrors the Delta and Imo model. Expanding HMO and federal formal sector uptake could help the state cross the 700,000 threshold.
7. Oyo – 671,298 Enrollees
Oyo State had 671,298 enrollees across multiple schemes. The SSHIA programme enrolled 209,730 residents, while the federal formal sector had 158,789. The BHCPF programme covered 116,805 people.
Notably, Oyo had 117,746 enrollees under the Tertiary Institutions Social Health Insurance Programme, TISHIP, one of the highest TISHIP numbers in the country. Private HMO enrolment was 30,414.
The presence of a large student population through TISHIP distinguishes Oyo from other states. This suggests that tertiary institutions can be a viable channel for expanding coverage among young Nigerians.
6. Imo – 701,147 Enrollees
Imo State recorded 701,147 enrollees, with the SSHIA programme accounting for 502,217 of that total. This represents 71.62% of all health insurance coverage in the state, making Imo one of the most SSHIA-dependent markets.
The federal formal sector contributed 105,080 enrollees, while private HMO enrolment was just 6,255. The very low private figure indicates that contributory insurance has yet to gain traction in the state.
Imo’s profile shows that a strong state agency can deliver significant numbers even in the absence of a vibrant private market. Scaling beyond 700,000 will likely require more federal and private sector participation.
5. FCT – 956,664 Enrollees
The Federal Capital Territory recorded 956,664 enrollees, making it the fifth-largest market. The federal formal sector was the biggest contributor with 383,875 enrollees, reflecting the concentration of federal civil servants in Abuja. HMOs followed with 223,062 enrollees.
The FCT’s SSHIA programme had 171,579 enrollees, while the BHCPF covered 67,624 residents. The strong HMO figure shows that Abuja’s urban, formal workforce has higher access to private health plans compared to many states.
As the seat of government, the FCT’s enrolment mix is skewed toward federal and private schemes. The data suggests that coverage in the capital is being driven by employment-based insurance rather than state-led mass enrolment.
4. Kaduna – 1,013,703 Enrollees
Kaduna completed the list of states with over one million enrollees, recording 1,013,703 at year-end 2025. The SSHIA programme accounted for 446,920 enrollees, while the federal formal sector had 265,144. The BHCPF programme covered 138,495 residents.
Private HMO enrolment stood at 47,864, higher than Kano but still well below Lagos. The balance between SSHIA, federal, and BHCPF enrollees indicates that Kaduna is leveraging multiple public channels to expand coverage.
Crossing the one-million mark places Kaduna among Nigeria’s health insurance leaders. The state’s approach suggests that combining state, federal, and BHCPF programmes can drive scale even without a large private HMO base
3. Kano – 1,232,683 Enrollees
Kano State emerged as the third-largest market with 1.23 million enrollees at the end of 2025. The SSHIA programme led the state with 593,368 enrollees, followed by the Basic Health Care Provision Fund, BHCPF, with 276,238 residents. The federal formal sector added 170,000+ enrollees.
Private HMOs recorded only 19,202 enrollees in Kano, a fraction of what was seen in Lagos. The low private uptake points to a market that is still largely dependent on public and subsidized programmes rather than contributory private plans.
Kano’s numbers show that northern states can achieve seven-figure enrolment when state and federal programmes are scaled. However, the limited HMO presence suggests more work is needed to deepen private sector engagement in the region.
2. Lagos – 2,757,892 Enrollees
Lagos State ranked second nationally with 2.76 million enrollees, making it the closest challenger to Delta. Unlike Delta, Lagos’ coverage is more diversified across multiple schemes. The SSHIA programme enrolled 1.10 million residents, while the federal formal sector recorded 256,525 enrollees.
Lagos stands out for its private HMO market. The state had 1.18 million residents enrolled under private HMOs, the highest in Nigeria. That figure alone represents more than half of the 2.17 million total HMO enrollees recorded nationwide, underscoring Lagos’ dominance in the private health insurance space.
The mix of state, federal, and private schemes in Lagos reflects the state’s large formal workforce and higher purchasing power. Its HMO numbers suggest that private sector participation will be critical if Nigeria is to close the coverage gap in urban centres.
1. Delta – 2,925,353 Enrollees
Delta State emerged as the leader in health insurance coverage with 2.92 million enrollees as of Q4 2025, according to NHIA data. The state’s performance was driven largely by its State Social Health Insurance Agency, SSHIA, which captured 2.77 million residents under its programme. This makes Delta the only state to cross the 2.7 million mark under a single state scheme.
The federal formal sector contributed 92,444 enrollees in the state, while private HMOs accounted for 27,204 enrollees. An additional 11,062 residents were covered under the NYSC Group, Individual, and Family Social Health Insurance Programme, GIFSHIP. The structure shows heavy reliance on the state-run scheme rather than private or federal platforms.
Delta’s lead highlights the impact of aggressive state-level enrollment drives. With its SSHIA programme carrying over 94% of the state’s total coverage, Delta provides a model for how sub-national health insurance agencies can scale enrolment quickly when prioritized.
