PMJAY for 70+ logged 700k treatments worth ₹1,471 crore in first year

Centre to ramp up awareness, with 15% of the 60 million senior citizen target covered, even as experts flag budgetary issues, slow pace

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The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which was expanded a year ago to include people aged 70 years and above, authorised over 700,000 treatments valued at ₹1,471 crore by October 2025 in that age bracket.

 

“This has significantly reduced out-of-pocket expenses for elderly beneficiaries by protecting them against catastrophic health costs,” an official told Business Standard.

 

Expanded in October 2024, the scheme has recorded over 9.26 million enrolments of people aged 70 years and above, according to officials from the National Health Authority (NHA), which is the execution body for PMJAY.

 

The government aims to cover around 60 million people in the age category, irrespective of income, with an assured ₹5 lakh annually to be shared within the family.

 

While all eligible beneficiaries can register for the scheme, elderly members of families that are already covered under PMJAY will have to re-register to receive an additional top-up cover of ₹5 lakh over the ₹5 lakh given to the family. 

 

According to NHA data, of the 9.4 million elderly registrations, 5.7 million have been made by new beneficiaries who did not previously come under the ambit of PMJAY, while the remaining 3.4 million are existing beneficiaries. 

Although the government has not provided any timeframe to reach the 60 million target, public health experts have raised concerns over a low coverage rate, which stands at around 15 per cent.

 

Commenting on the pace of work, Dr K Madan Gopal, advisor (public health administration), National Health Systems Resource Centre (NHSRC) and former senior consultant, NITI Aayog, said that the current operational friction, particularly the low enrolment among senior citizens, demands an urgent shift. 

 

“We must continuously refine our processes, specifically by organising proactive special enrolment camps and ensuring doorstep access for the elderly, alongside establishing a predictable, prompt financial settlement system for our empanelled hospitals,” he told Business Standard.

 

To counter this, the government is aiming to work on a hospital-level model for facilitating beneficiary assistance along with creating awareness through information, education and communication (IEC) programmes.

    

“With a view to facilitate beneficiary experience at hospital level, NHA has made provisions to deploy Pradhan Mantri Arogya Mitras (PMAMs) at public empanelled hospitals and provide on-ground facilitation for enrolment, verification and claim assistance,” the authority told Business Standard.

 

As for numbers, Uttar Pradesh, with 1.85 million registrations, has taken the lead in card registrations for those 70 years and above for new and existing beneficiaries. 

While the state has not given any projections for its card targets, its elderly population (aged 60 and above) was projected to be around 18.7 million in 2021, according to a report from the Ministry of Statistics and Program Implementation. 

Madhya Pradesh, second with 1.48 million new cards, has moved fast. The state government had projected a 3.4 million target for this age group at the time of the scheme’s launch, which makes it a 43 per cent achievement rate.

 

Third on the list is Kerala, with 708,041 new registrations. As of 2017 estimates, Kerala had around 1.7 million people in the age group of 70 years and above, which makes for a 41 per cent pick-up rate. The state’s overall elderly population is projected to be around 5.8 million, or 16.5 per cent of the state’s population. 

Meanwhile, card registrations have been comparatively slower in traditionally high-utilisation states of Tamil Nadu (206,640), Karnataka (202,348) and Telangana (26,439).

 

Speaking on this, Indu Bhushan, former chief executive officer (CEO) for Ayushman Bharat, said that budgetary constraints may have to play a role as states and hospitals may be finding it difficult to allocate resources.

 

“The present rates for PMJAY were approved in 2018. With medical inflation almost doubling since, states may find it difficult to sustain an additional load of beneficiaries without rate changes, especially in the case of geriatric care,” he added.

 

Under the expanded PMJAY, all senior citizens are to get a separate Ayushman Vaya Vandana Card, which is different from the Ayushman Card.

Rules also state that eligible beneficiaries covered under private health insurance policies or the Employees’ State Insurance Corporation (ESIC) scheme will also be eligible to avail benefits under PMJAY.

 

However, those already availing the benefits of the Central Government Health Scheme (CGHS) and Ex-Servicemen Contributory Health Scheme (ECHS) may have to either choose their existing scheme or opt for PMJAY.