Centre brings elders over 70 years under ambit of Ayushman Bharat scheme

As the country ages, the Union Cabinet on Wednesday approved expansion of health coverage under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to all senior citizens aged 70 years or above. The flagship health insurance scheme launched in September 2018 saw a further boost as the move aims to benefit approximately 45 million families, having 60 million senior citizens, with Rs 5 lakh free health insurance cover on a family basis.

With this approval, all senior citizens of the age 70 years and above, irrespective of their socio-economic status, would be eligible to avail of the benefits of AB-PMJAY. The beneficiary base expansion will be done at an outlay of Rs 3,437 crore. According to data available on the National Health Authority dashboard, the scheme has so far covered over 352 million citizens, who received free health insurance of Rs 5 lakh for hospitalisation.

The scheme provides cashless and paperless benefit cover of Rs 5 lakh per annum per family on a floater basis in empanelled hospitals across India. The eligible senior citizens would be issued a new distinct card under AB-PMJAY.

Senior citizens aged 70 years and above, who belong to families already covered under AB-PMJAY, will get an additional top-up cover up to Rs 5 lakh per year for themselves. The government clarified that they will not have to share this additional amount with the other members of the family who are aged below 70 years. All other eligible senior citizens, whose families are not covered under the scheme, will also get a cover up to Rs 5 lakh per year on a family basis.

Further, senior citizens of the age 70 years and above, who are already availing of benefits of other public health insurance schemes — such as Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), and Ayushman Central Armed Police Force (CAPF) — may either choose their existing scheme or opt for AB-PMJAY. Eligible senior citizens, who are covered under private health insurance policies or Employees’ State Insurance Corporation (ESIC) scheme will also be eligible to avail of benefits under AB-PMJAY.

The move is in line with the ruling Bharatiya Janata Party (BJP)-led government’s manifesto promise to increase the scheme’s coverage to include all senior citizens over 70 years.

Focus on senior citizens is understandable as recent data shows that the relatively young India today will turn into a rapidly ageing society in the coming decades.

According to the “India Ageing Report 2023”, prepared by the United Nations Population Fund (UNFPA) in collaboration with the International Institute for Population Sciences (IIPS), one-fifth of India’s population will comprise people above 60 by 2050.

The percentage of the elderly in India has been increasing swiftly in recent years, and the trend is likely to continue in the coming decades. The share of the population over the age of 60 years is projected to increase from 10.5 per cent in 2022 to 20.8 per cent in 2050. By the end of the century, the elderly will constitute over 36 per cent of the total population of the country. Sharp growth in the elderly population is observed from 2010 onwards along with a decline in the age group of below 15 years, indicating rapidity of ageing in India.

The scheme has witnessed continuous expansion despite a lack of participation and complaints of delays in reimbursements by empanelled hospitals. The scheme initially covered around 107.4 million poor and vulnerable families, comprising the bottom 40 per cent of India’s population.

The beneficiary base was revised to 120 million families in January 2022, considering India’s decadal population growth of 11.7 per cent over 2011 population. The scheme was further expanded last year to cover 3.7 million ASHAs and anganwadi workers and their families for free healthcare benefits.