The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), introduced in October 2018, offers hope to elderly individuals over 70 years old through comprehensive health insurance covering up to ₹5 lakhs annually. This extensive program aims to benefit around 6 crores of elders within approximately 4.5 crores of households nationwide, seeking to alleviate financial burdens related to medical expenses. Seniors living below the poverty line—who frequently forego necessary treatments due to fear of accruing debts—view this initiative as an answer to their prayers. However, underlying issues such as exclusions, regional implementation challenges, and logistical hurdles continue to pose significant obstacles. Consequently, these problems make life difficult for those most in need, turning what was intended to be a beacon of support into more of a distant dream rather than a tangible safety net.
An Ambitious Plan With Flaws
In theory, AB-PMJAY represents a significant breakthrough. It includes 1,929 medical procedures ranging from cardiac operations to oncology treatments, offering seamless service at both government and approved private healthcare facilities. No waiting periods apply; hence pre-existing ailments such as diabetes or high blood pressure fall under coverage immediately upon enrollment. Elderly individuals get an Ayushman Vaya Vandana Card, providing up to ₹5 lakhs of insurance per family unit. An extra allowance can be added for members within the same household already registered. This initiative might well provide critical surgical interventions for impoverished seniors without compelling them to sell their property or take out loans with exorbitant interest charges. Furthermore, due to its transferable nature, patients have access to services across all participating hospitals throughout the country—a substantial advantage for people who relocate frequently or enjoy traveling.
However, the initiative's scope is limited—it only covers secondary and tertiary healthcare, which means hospital treatment for severe illnesses. Primary care, outpatient services, and standard diagnostic procedures are not included at all. This poses significant challenges for an impoverished elderly woman living in a rural area. Suppose she suffers from ailments like arthritis or early-stage diabetes; she would require frequent medical consultations, medications, or lab tests just to maintain basic health. Unfortunately, such expenses fall outside of what AB-PMJAY will reimburse. Consequently, she might have to use whatever small savings she has, depend on her relatives, or forego necessary treatments entirely. Minor health problems could escalate rapidly, potentially leading to critical situations where hospitalization becomes inevitable—but accessing proper medical facilities isn’t always assured. Even when help finally arrives, permanent harm may already be done, or financial burdens—even those mitigated by insurance—could still push her finances over the edge.
Exceptions That Devastate the Underprivileged
The extensive list of exclusions under this program seems insurmountable for those with limited resources. Basic dental services such as fillings or dentures are only covered when they form part of a broader hospital stay. Conditions like HIV/AIDS, substance abuse treatment, weight management, and mental health concerns remain uncovered even though they frequently affect older individuals. Transplant procedures, which are typically considered critical interventions, seldom receive coverage either. Diagnostic exams conducted independently—such as an angiography to assess cardiovascular wellness—are also ineligible unless linked directly to another medical intervention within a healthcare facility. This leaves elderly people who live off modest pensions or day-to-day earnings without hope of affording necessary screenings or therapies. Consequently, many have little choice but to postpone seeking essential care, hoping fervently that their situation does not deteriorate further.
The ₹5 lakh ceiling, though substantial, applies collectively within the family unit. Within an impoverished home where several elders require support or ongoing medical conditions persist, these funds may be depleted rapidly. An extensive procedure such as a coronary artery bypass could consume most of this allowance, thereby limiting resources available for subsequent treatments or other affected individuals. Additionally, healthcare services under this scheme are confined to networked facilities, frequently located at considerable distances from rural regions. Consequently, an elderly person living in poverty might expend considerable time commuting, incur expenses related to transportation modes like buses or auto-rickshaws, and forfeit daily wages merely to access necessary treatment. To those eking out survival on ₹50 per day, what was intended as assistance transforms into yet another strain.
States That Shun
The lack of this program in regions such as Delhi and West Bengal stands out as a significant oversight. Political disagreements have hindered the implementation of AB-PMJAY, resulting in elderly individuals having no way to benefit from its provisions. Whether in the congested shantytowns of Delhi or the remote hamlets of West Bengal, underprivileged senior citizens depend solely on overburdened public healthcare facilities or expensive private medical centers beyond their means. This situation goes beyond merely lacking proper policies; it feels like an abandonment of those who are most defenseless, trapped amidst competing political interests. Given that the initiative was meant to be comprehensive, excluding whole states leaves countless elders struggling alone, facing uncertain health prospects.
Rural Realities: An Elusive Goal
In rural areas of India, many impoverished senior citizens find the AB-PMJAY initiative beyond their grasp. Despite having more than 26,000 enrolled healthcare facilities across the country, most are located in urban centers far away from village communities. This geographical gap is compounded by unreliable public transportation systems and expensive private alternatives. Although enrollment through the Ayushman mobile application is straightforward, this process presupposes easy access to smartphones, stable internet connections, or assistance for Aadhaar-based electronic Know Your Customer (e-KYC) procedures—a luxury unavailable to numerous elderly individuals. Health professionals stationed locally who should assist them frequently face overwhelming caseloads. Furthermore, awareness remains dismally low; some older adults remain oblivious to the program’s existence altogether. Instances of fraud, although mitigated by dedicated anti-fraud teams, still breed skepticism among beneficiaries due to allegations of inflated charges or denial of services at certain medical institutions. Consequently, what was intended as an accessible safety net seems unattainably remote rather than being a tangible support system for those struggling financially.
The Human Impact of Shortcomings
These disparities go beyond mere logistics; they touch upon fundamental aspects of humanity. Imagine an 80-year-old worker experiencing chest pains, struggling to pay for a standard heart examination since it isn't included in their coverage. Consider also a grandmother residing in a rural area of West Bengal, excluded due to her state's decision not to participate, as she watches her health decline. These individuals represent the shortcomings of AB-PMJAY. Those living below the poverty line face compounded challenges from both economic hardship and sickness, bearing the brunt of these issues. Each year, countless people fall deeper into financial distress due to direct payments for medical care, although AB-PMJAY has alleviated this problem somewhat for certain groups, numerous others still find themselves left behind owing to various restrictions and obstacles within the system.
When Will True Benefits Reach the Poor?
This initiative has the potential to benefit those in need, yet requires significant improvements. Firstly, it needs to encompass basic healthcare and outpatient department (OPD) services. Routine examinations and medications can help avoid hospitalizations, thereby improving outcomes and reducing expenses. Secondly, common diagnostic procedures such as blood tests or imaging scans ought to be integrated, regardless of whether they occur during hospital visits, so problems can be identified at an earlier stage. Thirdly, essential services including dental care, psychological assistance, and therapies for illnesses like HIV/AIDS are crucial—not optional—for older citizens. Fourthly, the administration should integrate all regions, particularly places like Delhi and West Bengal, guaranteeing comprehensive coverage without leaving anyone out. Lastly, increasing the number of enrolled medical facilities in remote locations along with organizing community outreach programs could significantly enhance accessibility.
Furthermore, actionable measures can significantly impact the situation. Health mobile units, fully stocked for diagnosis and essential treatments, have the potential to serve isolated rural areas effectively. Collaborations between national programs and community healthcare centers might provide affordable initial medical attention connected to AB-PMJAY initiatives. Publicity drives through mediums like regional-language radio broadcasts, influential locals, or folk theater performances could guarantee elderly individuals understand their entitlements under the program. Such endeavors are not unattainable ideals but realities within our grasp provided we muster sufficient governmental commitment. In addition, augmenting current efforts with privately funded insurance schemes would be ineffective since such coverage typically remains out of financial reach for low-income groups due to high premium costs. It falls upon the state authority to bridge this void directly by ensuring robust implementation of AB-PMJAY so that it genuinely acts as an economic safeguard against health-related bankruptcy for vulnerable populations.
A Vow Still Unfulfilled
The AB-PMJAY initiative for senior citizens embodies an ambitious aim; however, it resembles a bridge lacking crucial sections. Issues such as exclusions, disparities at the state level, and obstacles in accessibility disproportionately affect those who are less fortunate, compelling them to either endure silently or plunge into financial hardship. While this program holds the potential to reshape destinies, it must effectively reach the most marginalized populations—such as individuals residing in rural areas, urban slums, and remote regions across India—to fulfill its promise. Without addressing these deficiencies, countless elderly people may find their twilight years overshadowed by distress and destitution. There is room for improvement within our nation. We should strive to turn AB-PMYAY into a beacon of hope rather than a source of disappointment for those least able to cope.
(Girish Linganna, the writer of this piece, is an acclaimed science writer and a defence, aerospace, and political analyst located in Bengaluru. Additionally, he serves as the Director for ADD Engineering Components, India, Pvt. Ltd., which is a branch of ADD Engineering GmbH, Germany. For further contact details, you may email him at: girishlinganna@gmail.com)