Ayushman Bharat health insurance for senior citizens: How it works, who are eligible and what it will cost

The Centre's move to expand the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to cover citizens aged 70 years on Wednesday is  a significant shift in India's public healthcare landscape. By removing income-level restrictions, the scheme aims to offer much-needed health coverage to senior citizens, addressing their growing healthcare needs in the face of rising medical costs. 

This expansion, with a coverage of ₹5 lakh per family annually, is expected to provide substantial relief to a demographic that often struggles with managing disease burdens without a reliable social security net.

Previously, AB PM-JAY primarily catered to the economically disadvantaged, covering 40% of the population. Now, this expansion brings an additional 6 crore individuals from over 4.5 crore families under its umbrella. 

Each beneficiary aged 70 and above will receive a new health card, ensuring streamlined access to healthcare benefits.

The scheme’s coverage, however, is shared within families. If multiple senior citizens in the same family are eligible, the ₹5 lakh coverage will be divided among them. As clarified by Information and Broadcasting Minister Ashwini Vaishnaw, this move is essential as India witnesses a shift towards nuclear family structures, where the financial burden on elderly individuals is more pronounced.

For senior citizens already enrolled in other public health insurance schemes like the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), or Ayushman Central Armed Police Force (CAPF), a choice must be made between their existing plans and the expanded AB PM-JAY. However, those with private insurance or under the Employees’ State Insurance Scheme can opt for this new coverage without any conflict.

The rollout of this expanded coverage comes with an initial cost of ₹3,437 crore, with states covering 40% of the expenses. For hilly and northeastern states, the Centre will bear 90% of the costs. As demand increases, so will the coverage, according to Vaishnaw. 

Experts have indicated that this expansion, particularly catering to a growing elderly population, will likely cost more than covering younger, economically weaker sections of the population.

Eligibility for Senior Citizens Aged 70 and Above
All senior citizens aged 70 and above are eligible for ₹5 lakh health coverage under the scheme, applicable on a family basis.

Additional Coverage for Existing Ayushman Bharat Families
Senior citizens already covered under the Ayushman Bharat scheme receive an extra ₹5 lakh top-up on their health insurance, specifically for their own use, without needing to share it with family members.

Private Health Insurance Holders Can Also Benefit
Senior citizens with private health insurance policies can also avail of the scheme benefits without conflicting with their existing coverage.

Decision for Those Under Other Public Health Schemes
Senior citizens covered by CGHS, ECHS, or Ayushman CAPF must choose between their current public insurance or the new Ayushman Bharat health coverage.

Issuance of New Health Cards
All eligible senior citizens will be provided with a distinct card to access the scheme's benefits.