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Background: In recent years, the international health discourse has increasingly focused on achieving universal health coverage (UHC) through the provision of health insurance. Low- and middle-income countries (LMICs), such as Zambia, have adopted national health insurance schemes to improve health service delivery among their citizens. This study explored the role of Zambia’s National Health Insurance Scheme (NHIS) in strengthening the delivery of health services to the elderly at the district level in Zambia.

Methods: The study employed a qualitative case approach, and purposive sampling was used to select 22 participants for in-depth and key informant interviews. These included 14 elderly NHIS members, 6 staff members from health insurance facilities, and 2 NHIMA provincial office managers. The data was analysed using a thematic analysis approach. This was achieved by identifying patterns in service delivery and user experiences in accessing health services.

Results: The study findings revealed that the National Health Insurance Scheme (NHIS) has improved healthcare access for the elderly by offering affordable and increasing utilisation of services through accrediting facilities and reducing financial risks. Outreach efforts have helped register elderly members directly from their homes. However, challenges remain, including medication shortages, inadequate healthcare providers, long-distance travel, and system inefficiencies. The strategies to address the challenges include the government increasing medical subsidies, improving monitoring of the NHIS fund, policy reform to enhance equitable elderly care, and health infrastructure expansion.

Conclusion: While NHIS might have enhanced health service access among the elderly, service-related gaps still hinder its optimal effect. The challenges include limited health facility accreditation, shortages of medicines, and weak governance. Overcoming the barriers requires ethical NHIS reforms that promote better accreditation of healthcare, increased funding for improved infrastructure, and universal availability of medical services.