Anushruti Singh
In a landmark decision, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) – the world’s largest health insurance scheme – has announced free health coverage for all senior citizens aged 70 and above across India, irrespective of their income. The Union Cabinet’s approval this week marks a significant expansion of the scheme, aimed at addressing the growing demand for geriatric care as India’s elderly population is projected to double by 2050. By mid-century, one in five Indians is expected to be over 60.
“This expansion is set to benefit around 4.5 crore families, including 6 crore senior citizens, by providing them with free health insurance coverage of up to Rs 5 lakh per family,” stated the Ministry of Health and Family Welfare. “Every senior citizen in this age group will now have access to the scheme’s benefits, regardless of their socio-economic status.”
Under the new provisions, senior citizens will receive a distinct card for easy access to the scheme, a top-up coverage, and family coverage options. Those within families already covered by AB PM-JAY will be entitled to an additional top-up of Rs 5 lakh per year, specifically for senior members above the age of 70. For senior citizens not currently covered, a new family coverage plan will be offered, granting up to Rs 5 lakh per year.
Commenting on the expansion, Dr. Santy Sajan, Group Chief Operating Officer at Paras Health, said: “The government’s decision to expand the Ayushman Bharat scheme to include senior citizens aged 70 and above is a commendable and much-needed step towards ensuring that our elderly population has access to essential healthcare services. As India’s senior population grows, the demand for geriatric care is increasing, and this initiative is a timely response to that need. However, to make this expansion truly effective, it is crucial that reimbursement rates remain fair and payments are timely to ensure the active participation of healthcare providers, especially smaller hospitals and clinics.”
The new scheme offers flexibility, allowing senior citizens to opt for other public health insurance schemes like the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), Ayushman Central Armed Police Force (CAPF), or remain under AB PM-JAY. Even those covered by private health insurance or the Employees’ State Insurance scheme will be eligible for the benefits of AB PM-JAY.
Dr. Harsh Mahajan, Chair, FICCI Health Services Committee and Founder & Chief Radiologist, Mahajan Imaging, highlighted the implications for the healthcare infrastructure: “The inclusion of senior citizens under the Ayushman Bharat scheme marks a significant enhancement of our national healthcare infrastructure. However, expanding the beneficiary base by such a significant margin presents real-life challenges, particularly for smaller and medium-sized hospitals. Ensuring that reimbursement rates reflect actual costs and that payments are made promptly is crucial to prevent smaller providers from being overwhelmed and to maintain the quality of care for the elderly.”
Launched in 2018, AB PM-JAY has been a transformative initiative, providing universal health coverage across primary, secondary, and tertiary care, especially for vulnerable populations. The latest expansion aims to further strengthen India’s health sector by making healthcare more accessible and reducing the financial burden on families. However, as both experts suggest, the success of this initiative will depend on its effective and sustainable implementation, especially for smaller healthcare providers.
The expansion represents a critical step toward a more inclusive healthcare system, but its long-term success will hinge on addressing these challenges head-on to ensure it truly benefits the elderly population and the broader health ecosystem.
