Although imperative to Ghanaian citizens’ well-being, the National Health Insurance Scheme faces many sustainability challenges. The Scheme faces financial and operational challenges that have limited its viability and healthy for all people. Therefore, this study aims to review the financial and operational changes and sustainability of the Ghana National Health Insurance Scheme to offer policy guidance. The outcome showed that the intensity of community education is a key method for ensuring the National Health Insurance Scheme’s operational sustainability. Moreover, sourcing extra funding for the levies on large, profitable companies was found to be a possible strategy for ensuring financial sustainability. Finally, the study demonstrated that the existence of fraud and persistent corruption in health insurance schemes pose a threat to the sustainability of the Scheme. Conclusion and recommendations for future studies are discussed.