The Union Cabinet, chaired by Prime Minister Narendra Modi, has approved health coverage to all the senior citizens aged 70 years and above irrespective of income under the flagship scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).
This aims to benefit approximately 4.5 crore families with six crore senior citizens with 5 lakh rupees free health insurance coverage on a family basis.
The eligible senior citizens would be issued a new distinct card under AB PM-JAY. Senior citizens of 70 and above belonging to families already covered under AB PM-JAY will get an additional top-up cover of up to ₹5 lakh per year for themselves (that they do not have to share with the other family members below 70). All others of the age 70 years and above will get a cover up to ₹5 lakhs per year on a family basis.
Senior citizens (70+) who are already availing benefits of other public health insurance schemes such as Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), Ayushman Central Armed Police Force (CAPF) may either choose their existing scheme or opt for AB PMJAY. It has been clarified that senior citizens of 70 years and above under private health insurance policies or Employees’ State Insurance scheme will be eligible to avail benefits under AB PM-JAY.
AB PM-JAY is the world’s largest publicly funded health assurance scheme which provides health cover of ₹ 5 lakh per family per year for secondary and tertiary care hospitalisation to 55 crore individuals corresponding to 12.34 crore families. All members of the eligible families irrespective of age are covered under the scheme. The scheme has covered 7.37 crore hospital admissions including 49 per cent women beneficiaries. The public has benefited to the extent of over ₹ 1 lakh crore under the scheme.
The expansion of cover to senior citizens of the age of 70 years and above was earlier announced by the Prime Minister in April 2024.
Responding to this initiative, Dr Suman Katragadda, CEO, Heaps.ai stated, “Ayushman Bharat, an ambitious project of the Government of India has been providing healthcare access to all. One of the awaited group of individuals to be included as a part of this program were senior citizens. However, the program still has certain hurdles to overcome limited coverage for pre-existing conditions; many health insurance plans have exclusions or waiting periods for pre-existing conditions, which can be a significant problem for seniors who may have underlying health issues. This can leave them vulnerable to significant out-of-pocket expenses if they require treatment for a pre-existing condition. Thus creating a need for hospitalisation and repeat hospitalisations.
What is required is Preventive Care Coordination: A care management system can help coordinate preventive care services, such as regular check-ups and screenings. This can help identify potential health problems early on, leading to more effective treatment and reduced medical costs. This can be achieved through AI and help doctors/hospitals monitor patients and prompt any issues early on.”