The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) now covers citizens aged 70 years and above irrespective of their income. So Should You Enroll? If So, How?For most folks who would be reading this, we are a country in our prime, a country on the cusp of reaping the fruit of its demographic dividend. But, and a huge one at that, is the flip side of the same coin – Our demographic dividend might peak in the next 18 years. In about 18 years, we would be a country full of old men.
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India’s Aging Population: The Urgency for Health Coverage
Let’s look at some stats – In 2022, 149 million people in India were 60 or older, around 10.5% of the population. By 2050, this number is expected to double to 347 million, or 20.8% of the population.
The rate at which India’s elderly population is growing has been increasing. In the 1980s, the rate was just over 30% per decade, but by the 2020s it had increased to 40.6%. And it is precisely for this reason that the recent announcement of enhanced coverage under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a remarkable step in the right direction.
New Health Benefits Under Ayushman Bharat PM-JAY
The Government of India recently extended health coverage to all citizens above 70 years, irrespective of income or economic status. Previously, senior citizens from Economically Weaker Sections (EWS) were covered under the scheme, with an annual family cap of ₹5 Lakh.
Unfortunately, if a family faced multiple medical emergencies, they would have to resort to “Beg, Borrow, or Steal.” However, the recent announcement extends an additional ₹5 Lakh per year for senior citizens (aged 70 & above) within these families. Families with senior citizens under AB PM-JAY now have a total annual coverage of about ₹10 lakh, helping to meet the increased healthcare needs of older citizens.
Challenges Facing Ayushman Bharat PM-JAY
While the government scheme extension of Ayushman Bharat for the elderly is commendable, here are a few questions you should be asking if you’re considering enrollment.
- Will This Coverage Be Sufficient?
Given the rate of health inflation in the country, will this coverage be enough for your loved one’s medical needs? - Will Coverage Kick In When Needed?
Is the ecosystem robust enough to ensure that the claim process will work smoothly?
Limited Hospital Network and Reimbursement Delays
- Limited Network of Hospitals: The network of empaneled hospitals has not kept pace with demand. Although around 29,000 hospitals are empaneled, nearly three-quarters are overburdened government facilities.
- Reimbursement Delays: Managed by government authorities, reimbursement cycles can be elongated, creating a vicious circle where hospitals hesitate to join, and enrolled hospitals often seek upfront payments from patients rather than honoring scheme benefits.
Fraud and Misuse in Ayushman Bharat PM-JAY
The scheme also faces an estimated ₹13-15 Crore annually in fraud. This misuse wastes taxpayer money and prevents intended beneficiaries from receiving aid.
Alternatives to Ayushman Bharat for Enhanced Health Coverage
While Ayushman Bharat is a vital program, here are a few alternative options to consider for enhanced coverage:
- Buy a Base Health Plan: Although few insurers accept fresh policies for senior citizens, options are still available.
- Super Top-Up Health Plan: Use Ayushman Bharat as a base and add a Super Top-Up plan for higher coverage at affordable premiums.
- Group Health Policy as a Dependent Parent: If your child’s employer offers group health coverage, consider being added as a dependent, as these plans typically lack waiting periods for hospitalizations.
Is Enrolling in Ayushman Bharat PM-JAY the Right Choice?
Our take? Yes, of course, you should consider enrolling. The government seems committed to resolving infrastructure bottlenecks, and while challenges remain, improvements are likely on the way.
