Two years on, Ayushman cover reaches only 1.29 crore of 6 crore eligible seniors
Two years after senior citizens were brought under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) umbrella, only about 1.29 crore of an estimated 6 crore eligible seniors have been enrolled, according to figures cited by the National Health Authority (NHA).
The NHA has directed states and Union Territories to prioritise enrolling all eligible beneficiaries, expedite generation of Ayushman Cards, and ensure complete coverage of the senior-citizen cohort.
The enrollment gap persists despite the scheme extending free hospitalisation cover of up to ₹5 lakh a year to all citizens aged 70 and above, irrespective of income, since its expansion in 2024.
Implementation continues to lag in states that have not formally joined the scheme, limiting the pool of seniors who can even apply, independent of awareness or documentation hurdles elsewhere.
AB PM-JAY: Structure, Coverage and Beneficiary Base
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) is a centrally sponsored health insurance scheme launched on 23 September 2018 at Ranchi, Jharkhand, providing cashless secondary and tertiary hospitalisation cover of ₹5 lakh per family per year. It was originally targeted at roughly 10.74 crore poor and vulnerable families — about the bottom 40% of India's population — identified through deprivation and occupational criteria of the Socio-Economic Caste Census (SECC) 2011. The scheme is implemented by the National Health Authority (NHA), an attached office of the Ministry of Health and Family Welfare, in partnership with state governments and empanelled public and private hospitals.
Key Details
- Launch date: 23 September 2018; sum insured: ₹5 lakh per family per year, floater across family members.
- Original beneficiary base: about 10.74 crore families (roughly 50 crore individuals), selected via SECC 2011 deprivation/occupational criteria.
- Nodal implementing body: National Health Authority (NHA), which also drives enrollment monitoring, as reflected in its directive to states in this case.
The current enrollment shortfall concerns the newer senior-citizen extension of this same scheme, so understanding the base scheme's structure — family-floater cover, SECC-based targeting, and NHA's implementation role — is necessary to see why a universal, income-independent expansion for seniors required a fresh enrollment drive.
The 2024 Senior-Citizen Expansion (Ayushman Vay Vandana)
In 2024, the Union Cabinet approved extending AB PM-JAY health cover to all senior citizens aged 70 and above, regardless of income or existing AB PM-JAY eligibility, marking a shift from the scheme's original poverty-targeted design to a universal age-based entitlement for this cohort. Eligible seniors receive a distinct Ayushman Vay Vandana Card and an additional ₹5 lakh annual top-up cover for themselves, separate from and not shared with the family's existing PM-JAY cover if the household is already enrolled. The extension is estimated to cover about 6 crore senior citizens across roughly 4.5 crore families.
Key Details
- Approved by the Union Cabinet in 2024; distinct card (Ayushman Vay Vandana Card) issued to seniors aged 70+.
- Cover: ₹5 lakh per year, additional and exclusive to the 70+ individual, not pooled with other family members' existing PM-JAY cover.
- As of the latest data, the scheme's senior-citizen extension has not been implemented by West Bengal, limiting eligible enrollment in that state; other states, including Delhi, joined after initially not implementing it.
This news directly concerns the enrollment pace of this 2024 universal extension — the 1.29 crore of 6 crore figure measures how far actual card generation has progressed against the scheme's full eligible base, two years after the policy decision.
Health Financing Architecture: Hospitalisation Cover vs Primary Care
India's health financing architecture under Ayushman Bharat operates on two distinct pillars that are frequently conflated. AB PM-JAY covers secondary and tertiary care — that is, hospitalisation for defined medical and surgical procedures — through cashless, paperless treatment at empanelled hospitals. Separately, Ayushman Bharat Health and Wellness Centres, renamed Ayushman Arogya Mandirs, deliver comprehensive primary healthcare — screening for non-communicable diseases, maternal and child health services, and basic diagnostics — closer to where people live, without an insurance/reimbursement mechanism.
Key Details
- Health and Wellness Centres were envisaged from February 2018 with a target of 1.5 lakh centres; as of mid-2026, over 1.85 lakh Ayushman Arogya Mandirs are functional nationwide.
- AB PM-JAY (hospitalisation insurance) and Ayushman Arogya Mandirs (primary care) are administered under the same "Ayushman Bharat" umbrella but function as separate delivery mechanisms with separate targets and metrics.
- Low enrollment under PM-JAY's hospitalisation cover does not necessarily reflect on primary-care access through Arogya Mandirs, and the two should not be used interchangeably when assessing scheme performance.
The reported coverage gap concerns the hospitalisation-insurance pillar (AB PM-JAY/Vay Vandana card enrollment) specifically, distinguishing it from primary-care infrastructure expansion, which has progressed on a separate track.
Implementation Challenges: Federal Cooperation in a Centrally Sponsored Scheme
AB PM-JAY is a centrally sponsored scheme requiring state governments to sign a Memorandum of Understanding (MoU) with the NHA and share implementation costs (typically 60:40 Centre-state, with different ratios for hilly/North-Eastern states and Union Territories). This design means scheme rollout, including senior-citizen enrollment, depends on state-level administrative cooperation, cost-sharing willingness, and enrollment infrastructure such as Common Service Centres and hospital empanelment, not on central policy alone.
Key Details
- States must sign on to implement AB PM-JAY; a state's non-participation excludes its residents from the scheme regardless of national eligibility criteria.
- Enrollment bottlenecks commonly cited include low awareness among elderly beneficiaries, documentation and Aadhaar-linkage requirements, and uneven Common Service Centre/hospital infrastructure across states.
- The NHA's directive in this case — to prioritise enrollment, expedite card generation, and ensure complete coverage — reflects a routine centre-state coordination mechanism used to accelerate lagging rollout.
The gap between 1.29 crore enrolled and 6 crore eligible illustrates the practical friction in centrally sponsored scheme delivery — spanning both non-implementing states and on-the-ground enrollment delays even in participating states — which is the underlying governance issue the NHA's directive seeks to address.
- AB PM-JAY launched 23 September 2018 at Ranchi; cover of ₹5 lakh per family per year for secondary/tertiary hospitalisation; nodal body — National Health Authority.
- 2024 senior-citizen expansion (Ayushman Vay Vandana): universal cover for all 70+ citizens irrespective of income, additional ₹5 lakh per year, distinct Ayushman Vay Vandana Card.
- Estimated eligible senior-citizen population: about 6 crore, across roughly 4.5 crore families; enrolled so far: about 1.29 crore (per the reported figures).
- West Bengal has not implemented the senior-citizen extension; other previously non-participating states/UTs, including Delhi, have since joined.
- Ayushman Arogya Mandirs (Health and Wellness Centres): originally targeted at 1.5 lakh centres from 2018; over 1.85 lakh functional as of mid-2026, delivering primary care separate from PM-JAY's hospitalisation cover.