Centre extends Ayushman Bharat free health insurance to all above 70: How will it work?

As per the government’s announcement, all senior citizens, who are 70 and above, are eligible under the scheme. They will get a health cover of Rs 5 lakh on a family basis. Moreover, those aged 70 and above belonging to families that are already covered under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana will receive a top-up of Rs 5 lakh per year for themselves. They won’t have to share the cover with other members of the family.

The AB-PMJAY scheme, which began in 2018, is the world’s largest government-funded health insurance scheme. Currently, it serves 12 crore families and is viable to those who come from poor and vulnerable families, comprising the bottom 40 per cent of India’s population. It also covers 37 lakh ASHA workers across the country and their families for free healthcare benefits.

As per the government’s announcement, those who are covered under other public health insurance schemes like the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), Ayushman Central Armed Police Force (CAPF) may either continue their existing scheme or opt for AB-PMJAY.

Additionally, senior citizens of 70 years and above, who are under private health insurance policies or Employees’ State Insurance Scheme, will be eligible to avail benefits.

Union Minister Ashwini Vaishnaw also explained that if there are two senior citizens in the family, then the Rs 5 lakh coverage would be shared amongst them.

“This is a big step towards ensuring the social security of senior citizens, especially as India transitions to nuclear families,” he said.

The government said that the move to add those who are 70 and above will benefit 6 crore people across 4.5 crore families.

Eligible beneficiaries will be issued a new distinct card under the scheme, the government said.

Expanding the AB-PMJAY scheme to cover all those who are aged 70 and above will initially have an outlay of Rs 3,437 crore.

According to Vaishnaw, states will cover 40 per cent of the expenses. However, for hilly and northeastern states, the Centre will bear 90 per cent of the costs.

Adding all those who are aged 70 and above to the Ayushman Bharat health scheme is significant for multiple reasons. Firstly, it is the first time that the government has covered an entire age cohort, irrespective of their economic status or any other factors.

Secondly, with this move, the Narendra Modi government has fulfilled one of its poll promises. In April when releasing its poll manifesto, Narendra Modi had announced that senior citizens above 70 years of age and the transgender community will be brought under the ambit of the Centre’s health scheme Ayushman Bharat Yojana.

In June, President Droupadi Murmu in an address to Parliament had said the government will provide free treatment to the elderly above 70 years of age under the Ayushman Bharat scheme. At the time, she had said, “My government is going to take one more decision, all the elderly above 70 years of age will get the benefit of free treatment under the Ayushman Bharat scheme.”

Lastly, by expanding the scheme, the Centre is covering a larger base of people, especially the aged who need it the most. As per the Longitudinal Ageing Study in India, India’s population over the age of 60 is likely to rise from 8.6 per cent in 2011 to 19.5 per cent by 2050. According to the United Nations Population Fund (UNFPA), the current elderly population of 153 million (aged 60 and above) is expected to reach a staggering 347 million by 2050.

This growing number of aged people will have a far-reaching impact on the country’s health systems. Hence, health insurance coverage to this big group of people is noteworthy.

However, while most have lauded the Centre for the expansion of the Ayushman Bharat health scheme, there are some who are of the opinion that it comes into play only when a patient is admitted to hospital. However, it does not apply to out-patient department (OPD) services that form the bulk of the medical services sought by people.

In fact, a study published in the International Journal of Preventive Medicine revealed that nearly 40-80 per cent of expenditure on health is on OPD services in the country, forcing people to spend large amounts of money from their own pockets.