Cabinet approves ₹5 lakh health cover for senior citizens 70 and above

Cabinet on Wednesday approved to extend financial benefits under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana to all citizens aged 70 years and above.

The Cabinet chaired by Prime minister Narendra Modi on Wednesday approved to extend financial benefits under the government’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to all citizens aged 70 years and above, Union minister Ashwini Vaishnaw said while briefing on a slew of decisions. The coverage will be irrespective of the financial status of the beneficiaries.

Union minister Ashwini Vaishnaw further said that this was also a crucial step considering the major shift that is currently seen with families increasingly moving from joint to nuclear. (PTI)

Health coverage under the Ayushman Bharat health insurance scheme originally covered citizens belonging to poor and vulnerable families based on the deprivation and occupational criteria under the 2011 Socio-Economic Caste Census (SECC). The scheme provides a health cover of up to ₹5 lakh per family per year for cashless secondary and tertiary care hospitalisation.

“Our senior citizens will be extended universal health coverage under the Ayushman Bharat scheme is today’s big decision taken in the Union Cabinet. There is humanitarian thinking behind this decision, and there was a commitment made by the PM which has been fulfilled today,” said Vaishnaw.

The decision is likely to benefit about 4.5 crore families (6 crore senior citizens) as per government estimates. The overall beneficiary base currently is 12.3 crore families.

For the families presently covered having senior citizens, there will be additional shared top-up cover of up to ₹5 lakh per year under the scheme. And those middle or upper middle class families that are not covered under the scheme owing to their socioeconomic status will benefit with a shared cover of ₹5 lakh per year if they have senior citizens.

“The additional top-up coverage of up to ₹5 lakh will be allocated only for the senior citizens in the already covered families. The meaning of shared cover is that it will be shared between the senior citizens,” explained Vaishnaw.

Prime Minister Narendra Modi said his government is committed to ensuring accessible, affordable and top quality health care for every Indian. “We are committed to ensuring accessible, affordable and top quality healthcare for every Indian. In this context, the Cabinet today has decided to further expand the ambit of Ayushman Bharat PM-JAY to provide health coverage for all citizens above 70 years,” he posted on X.

He added that the scheme will ensure dignity, care and security to 60 million citizens.

Vaishnaw further said that this was also a crucial step considering the major shift that is currently seen with families increasingly moving from joint to nuclear. “In such circumstances, today’s decision is very relevant that will provide health coverage and social security to our senior citizens,” he added.

The additions will be rolled out soon and senior citizens will have to apply to avail themselves of the benefits. However, those senior citizens who are already covered under any of the health insurance schemes either under the central government or state government such as the CGHS (central government health scheme) or defence scheme will be offered a choice of the scheme they want to opt for.

“They will a have choice to decide whether they want to continue to remain in the scheme that they already are a part of or want to make a switch to the Ayushman Bharat scheme. Even those having private insurance will be eligible to come on board,” he said.

Eligible beneficiaries will be issued a new distinct card under the scheme. The initial outlay for the upgrade is ₹3,437 crore, and given that it is a demand-based scheme, Vaishnaw said that there is a provision for expanding the coverage in future.

Professor K Srinath Reddy, senior public health expert and former president, Public Health Foundation of India said: “The decision recognises that the elderly have many healthcare needs which require longterm medical attention and treatment. Chronic diseases, from heart diseases and diabetes to cancers and disabling arthritis, rise in frequency and severity as people age. Availability of personal finances for longterm care or hospitalisation is not assured among retirees. Coverage by PMJAY will enable the elderly to access needed healthcare without financial hardship.”

Reddy added: “However, this relief will only be partial if PMJAY does not cover outpatient care in addition to hospital care. Much of the healthcare expenditure for the elderly will be for chronic conditions which require prolonged, uninterrupted outpatient care and periodic diagnostic tests for monitoring multiple morbidities. Will the central government provide additional budgetary allocations to the PMJAY scheme, beyond that announced in the budget of March 2024? Will the states also provide their share for the additional financing of this scheme ? Even as we await clarifications on these, the promise of expanded coverage will bring cheer to many elderly who wish to be fit and functioning rather than frail and feeble or feel compelled to deny themselves the healthcare they need.”