Free health insurance up to ₹5 lakhs for citizens over 70 years under Ayushman Bharat PMJAY scheme

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY), as it is popularly known, currently is the largest government-funded health insurance for senior citizens scheme in the world. The main objective of this intervention is to provide economic cover for healthcare services to the economically vulnerable families of India.

On 12th September 2024 union information and Broadcasting Minister, Ashwini Vaishnaw announced that senior citizens above 70 years of age can get health insurance coverage of up to Rs 5 lakh per year per family. This expansion will ensure that millions of elderly nationwide will be guaranteed coverage for their medical treatments without facing financial burdens.

Launched on September 23, 2018, the Ayushman Bharat PMJAY scheme has emerged as a cornerstone of India’s healthcare system. Its primary goal is to reduce the financial burden of healthcare costs for low-income families, making medical treatment accessible to all.

The Ayushman Bharat consists of two major components:

• Health and wellness centers (HWCs): the government aims to establish 1.5 lakh HWCs to provide comprehensive primary healthcare services, focusing on preventive and promotive care.

• Pradhan Mantri Jan Arogya Yojana (PMJAY): this component offers financial protection against catastrophic health expenses, ensuring vulnerable families can access secondary and tertiary healthcare without significant financial hardship.

Senior citizens aged 70 years and above will now be eligible to benefit from the Ayushman Bharat PMJAY scheme, irrespective of their health condition.

The scheme provides:

• A ₹5 lakh health cover per family per year for those not already covered.
• Senior citizens who are already enrolled in the scheme will be given an additional rs 5 lakh.
• Senior citizens covered by other public schemes such as CGHS, ECHS, or CAPF can either continue their existing coverage or opt for Ayushman Bharat PMJAY.
• Those with private insurance or under ESIC are also eligible for ab PMJAY benefits.

To apply, follow these steps:

• Visit the official Ayushman Bharat PMJAY website.
• Verify your Aadhaar card or ration card at a PMJAY kiosk to authenticate your identity.
• Submit the necessary family identification documents.
• Once verified, you will receive an e-card with a unique ab PMJAY ID for future healthcare access.

The scheme ensures cashless treatment at public and private hospitals nationwide, benefiting approximately 4.5 crore families and 6 crore senior citizens through its expanded coverage.

The Ayushman Bharat PMJAY scheme offers several distinctive features that make it a vital resource for healthcare access, especially for senior citizens.

• Coverage amount: the scheme offers ₹5 lakhs per family per year, covering hospitalization expenses in both public and private hospitals.

• Target beneficiaries: over 12 crore families (50 crore individuals) from the bottom 40% of the population, based on the socio-economic caste census (SECC) 2011, are eligible for the scheme.

• Cashless transactions: beneficiaries can avail of cashless treatment without any upfront payments for covered medical procedures.

• No restrictions on family size or age: there are no limits on family size or age, and all pre-existing conditions are covered from day one.

• Nationwide portability: beneficiaries can access healthcare services from any empaneled hospital across India, irrespective of their home state.

The Ayushman Bharat PMJAY scheme offers numerous advantages to senior citizens health insurance, who often face high medical costs. Below are the major benefits:

• Cashless coverage: provides ₹5 lakh coverage per family annually, reducing the financial burden of catastrophic health expenses.

• Comprehensive coverage: covers all pre-existing conditions from day one, ensuring beneficiaries receive necessary treatments without delays.

• Wide reach: the project targets more than 10.74 billion families and provides comprehensive health services to less than 40% of the population.

• Portability: beneficiaries can avail of services at any empaneled hospital, making it easier to access care regardless of their location.

• Increased hospitalization: the scheme has been associated with a rise in hospitalizations, especially in private facilities, indicating improved healthcare access.

• Reduction in out-of-pocket expenditures: beneficiaries experience significant reductions in out-of-pocket expenses, easing the financial burden on families.

• Empanelment of hospitals: both public and private hospitals participate, improving the quality of care available to beneficiaries.

• Improved public health infrastructure: as more patients seek treatment in public hospitals, there is potential for improved infrastructure and services in these facilities.

The Ayushman Bharat PMJAY scheme has far-reaching implications for India’s healthcare system:

• Private facilities: PMJAY has led to a shift towards private hospitals, with a 4.6% increase in utilization and a 17% decrease in out-of-pocket expenditures.

• Budgetary pressures: rising utilization rates and economic impacts may exceed budget allocations.

• Dependence on state resources: disparities in implementation across states can lead to unequal access.

• Quality disparities: challenges in public hospital infrastructure and staff shortages.

• Empanelment issues: difficulties in meeting empanelment criteria may limit service availability.

Focus on hospitalization: limited coverage for outpatient and preventive care may increase long-term costs.

• Awareness gaps: limited understanding of the scheme’s benefits among eligible populations.

• Geographical and socioeconomic inequalities: persistent gaps in healthcare access and insurance coverage.

When compared to other global health insurance systems, Ayushman Bharat health insurance stands out due to its scale and coverage:

• Germany: it has a universal health insurance system where citizens are required to have health insurance, either through statutory health insurance or private insurance, covering a wide range of services including outpatient care.

• Canada: it employs a publicly funded healthcare system (Medicare) that covers all residents for medically necessary hospital and physician services, but does not cover outpatient prescription drugs universally.

• United States: The US has a mixed system where Medicare and Medicaid provide coverage for specific populations, while the Affordable Care Act expanded coverage options, but many still face high out-of-pocket costs.

The Ayushman Bharat PMJAY scheme has transformed healthcare access for millions of economically vulnerable families, especially with its new focus on senior citizens. Offering a health insurance policy with ₹5 lakh coverage, the scheme ensures that healthcare is accessible and affordable to those who need it the most. By addressing both financial and logistical barriers, Ayushman Bharat PMJAY is setting the stage for a healthier, more equitable India.

ARN: Zuno/Blog/DM/Free health insurance up to ₹5 lakhs for citizens over 70 years under Ayushman Bharat PMJAY scheme/09/24/01

All Rights Reserved.