The Freedom to Access Care Is Now the Freedom to Afford It

A Nation That Insures Health but Not Healthcare

AS 2025 draws to a close, Nigerians enrolled in health insurance schemes are discovering that coverage no longer guarantees care. Hospitals across the country have quietly raised service fees, triggering a domino effect that has forced Health Maintenance Organisations (HMOs) and the National Health Insurance Authority (NHIA) to hike annual premiums.

Market intelligence indicates further upward adjustments in 2026, coinciding with worsening inflation, rising pharmaceutical costs, and shrinking disposable income. Unlike previous years when healthcare cost shocks were largely absorbed by uninsured households, the burden has now shifted into the insurance pool itself, pricing out even those who tried to do the “responsible” thing by enrolling.

Data gathered from patients and insurance providers shows the most dramatic jump in the Standard Package, previously sold at ₦15,000–₦25,000 for individual or family plans. The same plans now cost ₦35,000–₦65,000 per year — representing a 120%–160% rise. Comprehensive plans have followed the same inflationary curve, with Gold and Platinum tiers now selling from ₦100,000 to ₦1 million and higher per annum, depending on provider networks and service depth.

But while insurers blame inflation, patients blame the system.

For many policyholders, the dilemma is now binary: pay more to remain insured or pay cash to remain alive.

The Hidden Trade-Offs in ‘Affordable’ Plans

Investigations reveal that lower-cost insurance packages marketed to traders, families, and informal workers are indeed cheaper, but come at a steep non-financial cost: delayed approvals, longer hospital wait times, inferior medications, and reduced treatment quality. These plans are often deprioritised by hospitals, whose profit margins have been wiped out by inflationary pressures that reimbursements have failed to match.

At Mushin Market in Lagos, where the realities of poverty meet the risks of sickness daily, trader Ifeoma Okeke captured the mood of millions: modest premiums once covered routine check-ups and basic medications; today, they have doubled or tripled. Families now ration food, not healthcare — and insurance, once a safety net, is fast becoming a luxury.

HMOs privately admit that plan upgrades of 30%–40% are now required to unlock moderate-to-good service quality at partner hospitals. But the public asks: what exactly were they paying for before the upgrade?

The answer is uncomfortable: access, not quality.

Hospitals Fight Back With Price Tags

Private healthcare providers argue that premium hikes are not arbitrary but reactive. Dr. Gbadebo Adebiyi, National Secretary of Private Medical Doctors, explained that while insurance premiums rose by about 100%, drug costs skyrocketed by over 400% in many cases, making the increases by hospitals economically unavoidable.

To drive home the argument, Adebiyi noted that the cost of a single malaria drug — one of the most commonly prescribed medications in Nigeria — now exceeds the Standard premium itself. A malaria diagnosis also rarely ends at one drug, as pain relievers, vitamins, antibiotics, and symptom-specific prescriptions follow.

Hospitals, he said, are not hiking fees because they want to, but because they must.

A System Hemorrhaging Providers and Patients

The insurance crisis is now bleeding into national healthcare capacity. Hospitals are refusing insurance patients. Doctors are resigning, relocating, or emigrating. Facilities are declaring bankruptcy, shutting down, or pivoting to cash-only care. According to providers, many private hospitals would rather close than operate at a guaranteed loss.

The larger tragedy is this: Nigeria is not losing its insurance culture; it is losing the system that should reward it.