This study explains why Nepal needs to strengthen its National Health Insurance Program (NHIP) to better shield households from the financial impact of health care costs and achieve its ambitious goal of universal health coverage by 2030. Despite a raft of government subsidies, the study shows only 23% of the population is covered by NHIP with limited digitalization, outdated benefits, and insufficient financial sustainability assessments among issues limiting uptake. It sets out recommendations that include increasing the number of facilities in the NHIP program, expanding coverage to ultra-poor citizens, and improving risk pooling to ensure everyone has access to equitable health care.