Explainer: Ayushman Bharat scheme to cover all seniors over 70; read more here

The move is aimed at easing the financial burden of healthcare on the elderly, who face high medical costs without sufficient social security support

Update: 2024-09-12 10:36 GMT
With the Cabinet’s new decision, every citizen aged 70 or older will receive ₹5 lakh of annual health coverage for their family | File photo

The Union Cabinet has expanded the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to include citizens aged 70 and above.

Now, people in this age group will get health coverage under the scheme, regardless of their income. Previously, only the economically weaker families – estimated to comprise bottom 40 per cent of the population – were eligible for benefits under the scheme.

The move is aimed at easing the financial burden of healthcare on the elderly, who face high medical costs without sufficient social security support.

Here is all you need to know about the revised version of the scheme:

What is AB PM-JAY?

Under the scheme, the central government used to provide annual health insurance coverage of Rs 5 lakh to the bottom 40 per cent of India’s population. The amount is meant to be shared by all family members, regardless of regardless of age, to help cover the costs of medical treatments, surgeries, and hospital stays.

The government has now extended the scheme to people above 70 years irrespective of their backgrounds.

How will the new expansion work?

As part of the Centre’s latest decision, every Indian citizen aged 70 or older will receive Rs 5 lakh of annual health coverage for their family.

The expansion is expected to benefit an additional 6 crore people, which includes about 4.5 crore families.

What if senior citizens already have health insurance?

Senior citizens who are already covered by other government schemes like the Central Government Health Scheme (CGHS) or the Ex-Servicemen Contributory Health Scheme (ECHS) can choose to continue with those or switch to the Ayushman Bharat scheme.

Senior citizens meeting the age criterion and who are under private insurance policies or Employees’ State Insurance Scheme will also be eligible to avail benefits under AB PM-JAY.

What about elderly in families already covered under scheme?

The government has clarified that eligible senior citizens, who belong to families covered under AB PM-JAY, will get an additional (shared) top-up cover of up to Rs 5 lakh per year for themselves.

What if there are multiple seniors in a family?

If a family has two or more senior members who are aged 70 or above, the Rs 5 lakh coverage will be shared among them. This approach helps provide financial protection as more Indian families transition to smaller, nuclear family structures.

Why was the expansion important?

This is the first time a specific age group – citizens aged 70 and above in this case – is getting targeted health coverage under Ayushman Bharat. India’s population is aging rapidly, with the percentage of people over 60 expected to nearly double by 2050. In absolute numbers, that’s a rise from 103 million elderly people in 2011 to 319 million by 2050. At present, only around 20 per cent of this group has health insurance, highlighting the need for such a policy.

How is the expansion funded?

The scheme's initial rollout will cost Rs 3,437 crore. Most states will cover 40 per cent of the cost, while states in hilly and north-eastern regions will receive more support, with the central government covering 90 per cent of the expenses. The scheme is designed to grow in scale as demand increases, ensuring coverage expands as needed.


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