To address the higher risk faced by producers in agricultural production and sales from the farm gate, the government of Nepal launched an agriculture insurance program in the fiscal year 2013/14 with a significant subsidy on insurance premiums. After 10 years of the program’s implementation, this study found that agricultural insurance covers 4.4% of total farmer participation and 3% by insured value to agricultural gross domestic product (GDP). This indicates that a thorough review of agricultural insurance policies, programs, and outcomes in Nepal is urgently needed to assess the effectiveness of public investment and identify areas for improvement. The aim of this chapter is to examine the features and performance of the programs, the significance of the program in the context of risk coverage, status of claim settlements, technical challenges, and other implementation problems. Additionally, the study analysed the outcomes of the crops and livestock insurance programs in comparison to a huge public investment, primarily in the form of an insurance premium subsidy to producers. This study has also assessed and presented lessons learnt from similar agricultural insurance programs overseas. Recommendations and the way forward from this study could be helpful in supporting policy guidance to provide a roadmap for sustainable and efficient agricultural insurance programs in Nepal, thereby supporting the overall transformation of agriculture in the country. The study identifies a wide gap between insurance premium and loss rates: premium rates need to be properly analysed, and coverage level cautiously reduced from 90%, which would reduce the cost of premiums. Additionally, to reduce the huge government stake in agricultural insurance, there is a need to prioritize crop and livestock species for providing premium subsidies and focus on climate-resilient insurance programs.