Ayushman For Senior Citizens

CENTRAL GOVERNMENT has announced extension of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPM-JAY) to all senior citizens aged 70 and above, irrespective of their socio-economic status. It now covers an additional six crore senior citizens.

ABPM-JAY, launched six years ago, is the world’s largest government-funded health insurance scheme in terms of coverage. It provides health cover of ₹5 lakh per family per year for secondary and tertiary care hospitalisation to 55 crore beneficiaries in 33 states and Union Territories, excluding Delhi, Odisha and West Bengal, and provides cashless inpatient services for all pre-existing diseases from day one. It covers 1,949 medical procedures across 27 specialties such as general medicine, surgery, oncology and cardiology. It also provides hospital services, including 15-day medication post discharge, diagnostics (up to three days before admission), food and lodging. The scheme operates through a robust IT platform. The services are paperless and cashless. Beneficiaries from one state can avail treatment in any empanelled hospital across India.

With seven crore treatments worth ₹1 lakh crore so far, the expanded coverage for senior citizens will help insurance sector and healthcare providers, specifically the 12,696 private hospitals in the list of 29,648 hospitals under the scheme (as on September 1, 2024).

“The extension of the scheme is a welcome move for the public. For insurance sector, this highlights government’s commitment to expanding universal healthcare, reshaping the market for senior citizen health plans. It also strengthens India’s position as it progresses towards becoming a developed economy and a healthier and more inclusive society,” says G. Srinivasan, MD & CEO, Galaxy Health Insurance Co. Ltd.

Healthcare providers say the scheme can incentive them to expand to smaller cities and towns. “This not only enhances healthcare access for the elderly but also addresses a critical gap in chronic care management, particularly for conditions like kidney disease. With many dialysis patients being senior citizens, the policy will help more people access life-saving dialysis treatments without financial constraints,” says Prabhat Srivastava, founder, Vitus Care, a tech-driven dialysis services player.

While there is no doubt about the benefits of the scheme’s expansion, it’s one more step towards universal health insurance. According to a report by government think tank Niti Aayog, 30% of the population, around 40 crore people, does not have health cover despite introduction of Ayushman Bharat, various state and Central government schemes and private health insurance. The inclusion of senior citizens can bring in only another six crore people into the safety net, leaving close to 34 crore people, young and old, to fend for themselves.

This is not a small number. Further expansion of ABPM-JAY or similar schemes that protect, perhaps, women and children, or patients with specific life-threatening illnesses like cancer, should be the way forward. Health insurance for all should be the objective. Models can vary.