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This study evaluated the reach and factors influencing enrollment in state-supported health insurance schemes (SSHIS) across six Nigerian states, each representing a different geopolitical zone. Findings showed significant variation in coverage—highest in Kwara State (37.3%) and lowest in Enugu State (1%)—with satisfaction levels also differing, and lack of awareness emerging as the most consistent barrier to enrollment. The authors conclude that poor awareness, financial constraints, and dissatisfaction are major obstacles to SSHIS success in Nigeria, recommending broad educational campaigns and greater integration of health insurance schemes to boost coverage and sustainability.