Background : This study examined the challenges in the implementation and scale-up of the National Health insurance Scheme (NHIS) in Nigeria. Materials and Methods : We designed this descriptive cross-sectional study to investigate the knowledge and opinions of 150 randomly selected adults in urban Kano regarding the NHIS. Data was analyzed using Epi Info™ 3.2.05 statistical software. Respondents' knowledge of NHIS was scored and graded using a system adapted from previous studies. Results : The mean age of respondents was 39.1 ± 11.1 years, and the majority were currently married (76.7%), males (76.0%), had formal education (82.0%), and were civil servants (52.7%). More than half (52.0%) of the respondents had poor knowledge of the NHIS. Respondents' knowledge of NHIS did not differ significantly by age, sex, ethnicity, marital status, educational level, or occupation. Although the majority (74.7%) opined that the NHIS is a good initiative, a significant proportion was pessimistic about the scheme: 31.3% said that it is a good scheme but not practicable and 28.0% felt that it is only for the rich. Conclusion : In view of the poor level of knowledge and the pessimism about the NHIS, the government/NHIS office should expedite the implementation of the package for the under-five children and/or the disabled to demonstrate the usefulness of the scheme. The Federal Ministry of Health, the NHIS, and the development partners should intensify efforts for public enlightenment, using electronic and print media as well as other traditional methods of communication.