Ayushman Bharat PMJAY- Cabinet approves health cover for senior citizens aged 70 & above

For many senior citizens in India, concerns about managing their health and the associated financial burdens have been constant sources of anxiety.

However, in a landmark decision on September 11, 2024, the Union Cabinet approved a significant expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), extending health coverage to senior citizens aged 70 and above, regardless of their income. This expansion aims to alleviate the healthcare burden for aging citizens in India and represents a transformative shift in the country’s public healthcare landscape.

Key Announcement

Union Minister Ashwini Vaishnaw announced that the enhanced coverage will be implemented "soon," bringing much-needed relief to millions of senior citizens. Prime Minister Narendra Modi supported the initiative, emphasizing its impact on ensuring "dignity, care, and security" for an estimated six crore citizens. The expansion underscores the government’s commitment to accessible and affordable healthcare for all.

Eligibility and Benefits

• Eligibility Criteria:

  • All senior citizens aged 70 years and above are eligible for the expanded AB-PMJAY coverage.

  • They will receive a health cover of Rs 5 lakh on a family basis. Seniors already covered under the AB-PMJAY scheme will receive an additional Rs 5 lakh per year for themselves, without having to share the cover with other family members.

• Existing Coverage:

  • The AB-PMJAY scheme, launched in 2018, is the world’s largest government-funded health insurance scheme. It currently covers 12 crore families from economically disadvantaged backgrounds and includes 37 lakh ASHA workers and their families.

  • Beneficiaries covered under other public health insurance schemes like CGHS, ECHS, and Ayushman CAPF may choose to continue with their existing scheme or opt for AB-PMJAY.

  • Senior citizens with private health insurance policies or under the Employees’ State Insurance Scheme are also eligible for the expanded benefits.

• Coverage for Multiple Seniors:

  • If two senior citizens in a family are eligible, the Rs 5 lakh coverage will be shared between them, as explained by Union Minister Ashwini Vaishnaw.

Impact and Reach

• Beneficiaries:

  • The expansion will benefit approximately 6 crore people across 4.5 crore families.

  • New distinct cards will be issued to eligible beneficiaries under this expanded scheme.

• Financial Outlay:

  • The initial cost of expanding the AB-PMJAY to cover those aged 70 and above is estimated at Rs 3,437 crore.

  • States will bear 40 percent of the expenses, while the Centre will cover 90 percent of the costs for hilly and northeastern states.

Significance of the Expansion

• Historic Inclusion:

  • This is the first time the government has extended coverage to an entire age cohort irrespective of economic status.

  • The expansion fulfills a key promise from the Narendra Modi administration’s poll manifesto and aligns with President Droupadi Murmu’s earlier assurance of free treatment for the elderly.

• Addressing Demographic Shifts:

  • With India’s elderly population expected to rise significantly by 2050, this move is crucial for addressing the growing healthcare needs of the aged population.

  • The Longitudinal Ageing Study in India projects that the population over 60 will increase from 8.6 percent in 2011 to 19.5 percent by 2050, highlighting the urgency of comprehensive healthcare coverage.

Challenges and Criticisms

While the expansion is widely praised, some critics argue that the scheme’s benefits are limited to inpatient services and do not cover outpatient department (OPD) services, which constitute a substantial portion of healthcare expenditure. A study published in the International Journal of Preventive Medicine indicates that a significant percentage of health expenses are incurred in OPD services, often requiring substantial out-of-pocket spending.

The expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana marks a pivotal step in enhancing healthcare accessibility for India’s senior citizens. By extending coverage to all individuals aged 70 and above, the government aims to provide a safety net for one of the most vulnerable segments of the population. As India continues to navigate demographic changes, this initiative will play a crucial role in ensuring that aging citizens receive the care and security they deserve.

With inputs from agencies

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