India Extends Ayushman Bharat Health Insurance to All Senior Citizens: Eligibility and Details

Sept. 12, 2024, 4:20 a.m.

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The concern of rising healthcare costs for elderly individuals in India has been addressed with the recent expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). The Union Cabinet has approved extending health insurance coverage to all senior citizens aged 70 years and older, regardless of their income.

Union Minister Ashwini Vaishnaw announced on Wednesday that this expansion will be implemented soon.

Prime Minister Narendra Modi expressed his support for the initiative on X, stating, “We are committed to providing accessible, affordable, and high-quality healthcare for all Indians. This program will ensure dignity, care, and security for six crore citizens!”

This signifies a major transformation in the country's public healthcare system, offering a safety net for health management to individuals over the age of 70.

But how will this work? Who qualifies for this scheme? What will the cost be? We address all these questions and more.

Who’s eligible for the scheme?

According to the government’s announcement, all senior citizens aged 70 years and above are eligible for the scheme. They will receive a health cover of Rs 5 lakh per family. Additionally, those aged 70 and above belonging to families already covered under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana will receive a supplemental coverage of Rs 5 lakh per year for themselves. This top-up benefit is independent of the family coverage.

The AB-PMJAY scheme, launched in 2018, is the world’s largest government-funded health insurance program. Currently, it serves 12 crore families, primarily those from economically disadvantaged backgrounds, representing the bottom 40 per cent of India’s population. The scheme also extends free healthcare benefits to 37 lakh ASHA workers across the country and their families.

According to the government’s announcement, individuals covered by other public health insurance programs such as the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), and Ayushman Central Armed Police Force (CAPF) have the option to either maintain their current coverage or choose to enroll in AB-PMJAY.

Moreover, senior citizens aged 70 years and older, who are enrolled in private health insurance policies or the Employees’ State Insurance Scheme, will be eligible to receive benefits from this program.

Union Minister Ashwini Vaishnaw further clarified that if a family includes two senior citizens, the Rs 5 lakh coverage will be divided equally between them.

“This significant step aims to enhance the social security of senior citizens, particularly as India transitions towards nuclear family structures,” he stated.

Advertisement How many people would benefit?

The government emphasized that this expansion to include individuals aged 70 and above will positively impact an estimated 6 crore people spanning 4.5 crore families.

Eligible beneficiaries will receive a unique, distinct card under the scheme, the government announced.

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), launched in 2018, is the world's largest government-funded health insurance program. What will be the cost of extending coverage to all individuals over 70 years of age?

Expanding the AB-PMJAY scheme to include all those aged 70 and above will initially require an allocation of Rs 3,437 crore.

According to Vaishnaw, state governments will contribute 40 percent of the expenses. However, for states in hilly regions and the northeast, the central government will bear 90 percent of the costs.

Advertisement Why is this significant?

Enrolling all individuals aged 70 and above into the Ayushman Bharat health scheme is significant for several reasons. First, it is the first instance where the government has provided coverage for an entire age group, regardless of their financial situation or any other factors.

Secondly, this move fulfills a campaign promise made by the Narendra Modi government. In April, while releasing its election manifesto, Narendra Modi had pledged to include senior citizens over 70 years of age and the transgender community under the coverage of the Ayushman Bharat Yojana, the Centre's health scheme.

In June, President Droupadi Murmu, in her address to Parliament, stated that the government would provide free healthcare to elderly individuals over 70 years of age under the Ayushman Bharat scheme. At the time, she said, “My government is taking a further step, all those above 70 years of age will be eligible for free treatment under the Ayushman Bharat scheme.”

Advertisement Furthermore, by extending the program, the government is reaching a wider range of individuals, particularly the elderly who rely on it the most. According to the Longitudinal Ageing Study in India, the proportion of India's population over 60 is projected to increase from 8.6 percent in 2011 to 19.5 percent by 2050. The United Nations Population Fund (UNFPA) estimates that the current elderly population of 153 million (aged 60 and above) will surge to a remarkable 347 million by 2050.

This escalating number of senior citizens will have a substantial impact on the nation's healthcare systems. As a result, providing health insurance coverage to this large segment of the population is significant.

However, while many commend the government for expanding the Ayushman Bharat health program, some argue that its benefits primarily apply when a patient is admitted to a hospital. It does not, however, cover outpatient department (OPD) services, which constitute the majority of medical services sought by people.

In fact, a study published in the International Journal of Preventive Medicine revealed that nearly 40-80 percent of healthcare expenditures in the country are allocated to OPD services, compelling individuals to bear substantial financial burdens from their own pockets.

With inputs from agencies