Health cover for senior citizens: What is the Ayushman Bharat PM-JAY expansion PM Modi is launching

The Union cabinet approved the expansion of the AB PM-JAY health cover to all Indians of age 70 years and older, irrespective of their income, in September.

AB PM-JAY is already the world’s largest public health insurance scheme. It provides free cover upto Rs 5 lakh annually to all members of eligible families — estimated to comprise the bottom 40% of the population economically — irrespective of age.

Expansion of the cover to the country’s entire elderly population was one of the BJP’s key promises before the Lok Sabha polls. This is now the first complete age-cohort to receive coverage under the scheme.

How to register for Ayushman Bharat scheme

Those eligible for the expanded cover will be able to register themselves and get the Ayushman Bharat card as soon as the new module is added to the existing portal.

Beneficiaries can register either through the government’s Ayushman App or at the Ayushman Bharat counter at any government health facility. Anyone who has turned 70 as per their Aadhaar can register for the new health cover.

There will be no exclusions or waiting period of pre-existing conditions. Beneficiaries will be able to utilise their policy as soon as they complete their eKYC. The portal will also be face-authorisation-enabled, to ensure that elderly persons whose fingerprints are difficult to read or have changed over time can avail the benefits.

Cover, beneficiaries under Ayushman Bharat

Everyone of age 70 or more will be entitled to a cover of Rs 5 lakh annually, shared within the family. This means if there are two elderly beneficiaries in the household, the cover will be split among them.

Elderly members (age 70 and more) of families that are already covered in accordance with their economic status will get a top-up cover of Rs 5 lakh — to be used only for the elderly. These elderly beneficiaries will have to re-register to receive the top-up cover.

The scheme will cover almost 6 crore individuals (from 4.5 crore families), of whom 1.78 crore are already covered by the scheme. “For the additional top-up amount, the financial implication is very little,” a senior official said.

The Ayushman Bharat scheme already covers 1,670 procedures across 26 specialities, which includes 25 geriatric packages. More packages for the elderly are in the process of being added, officials said.

Those already covered 

Some 80 lakh people are separately covered under various government health schemes — the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme, or cover provided to family members of defence and railway personnel, etc.

Those who are covered under these government health schemes will have the option of choosing either Ayushman Bharat or continuing with their existing coverage.

People who are covered under the Employees State Insurance Corporation (ESIC), however, will be eligible to have both their existing cover and Ayushman Bharat. This is because premiums for ESIC are paid by the insured and their employer, not the government.

People who have their own privately purchased insurance cover will be eligible to have the Ayushman Bharat cover as well.

Cost to government

The initial outlay from the Centre for the expansion of the scheme will be Rs 3,437 crore. This will cover the costs for the six months in the current financial year and all of next year, officials said. States will have to contribute 40% to the cost of the scheme.

Ayushman Bharat has not been implemented by Delhi, West Bengal, and Odisha. Officials said that Odisha is currently in talks with the Centre to launch the scheme.

Why the scheme matters

Making health cover universal over the age of 70 is very significant as India’s population ages. More Indians are likely to need health facilities in the coming years, and much of the population is currently under-covered by health schemes.

📌 At the time of the 2011 census, only 8.6% of India’s population was over the age of 60 years. This is expected to increase to 19.5% by 2050, according to the government’s Longitudinal Ageing Study in India (LASI). In terms of numbers, Indians over the age of 60 are likely to be 319 million in 2050 — up more than three times from the 103 million in 2011.

📌 Older Indians are much more likely to be hospitalised and to stay in hospitals for longer. The rate of admission among the elderly already covered under the scheme has been more than 7% — double the 3-4% admission rate for the younger people covered under the scheme, according to officials.

An analysis of Ayushman Bharat data by The Indian Express earlier had shown that almost 12% of all admissions and 14% of the money reimbursed under the scheme was for those who were of age 70 years or older.

📌 The elderly remain largely uncovered by any health scheme. Just over 20% of India’s population above the age of 60 is currently covered by any government, employer-provided, or personal insurance scheme, according to the India Ageing Report 2023.

📌 Women make up the larger share of the elderly population — a survey by NITI Aayog found that 58% of the elderly are women, and 54% among them are widows. “This presents a substantial challenge because they may not have healthcare support. This scheme will be of immense help to women, especially those who are widowed,” an official said.