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Abstract The recent Lancet Commission on Nigeria’s health system highlighted high out of pocket expenditures on health and underfunding of the public health sector as major obstacles to Nigeria’s achievement of the Sustainable Development Goals. Nigeria has sought to address these gaps by extending health insurance coverage. This paper measures health insurance coverage and access to care in Nigeria circa 2023, using the first round of the People’s Voice Survey (PVS). We analyze health insurance coverage by calculating coverage rates and using multivariate logistic regression to estimate associations between insurance coverage, socioeconomic characteristics, and health system utilization. In 2023, only 2% of Nigerians had insurance from the National Health Insurance Scheme; higher education and higher income levels were the most notable predictors of NHIS access. Chronic illness and self-reported health were not associated with insurance status. Respondents with insurance were less likely to use public sector primary care providers as their usual source of care, and were more likely to use private hospitals. Those with insurance are also more likely to have had an inpatient hospitalization in the preceding year, and more likely to have received key preventive screenings. While those with insurance receive more and better care in Nigeria, insurance access has been limited to relatively advantaged population groups. Rapid mobile phone-based surveys such as PVS could help policymakers in Nigeria track insurance coverage and whether it contributes to reversal of these trends over time.