Ayushman Bharat Scheme For Senior Citizens Above 70: Is It Enough?
  • Why separate policy for senior citizens?
  • AB-PMJAY for senior citizens
  • Top health insurance for senior citizens
Ayushman Bharat Scheme For Senior Citizens Above 70: Is It Enough?
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Ayushman Bharat Scheme For Senior Citizens Above 70: Is It Enough?

Senior citizens are the wise and experienced people of our society. The Indian government is taking significant steps to take care of their financial needs. The Ayushman Bharat scheme is one of those steps towards their betterment. Let us learn more about the Ayushman Bharat scheme below.

What is the Ayushman Bharat Scheme: PMJAY?

The Pradhan Mantri Jan Arogya Yojana (PM-JAY) is also known as the Ayushman Bharat Yojana. It is a flagship programme launched by the Government of India in 2018, for the bottom 40% of the Indian population. Know more about Ayushman Bharat-PMJAY here. It gives coverage of Rs 5 Lakh, which is quite good but not enough in the case of senior citizens.

First things first, AB-PMJAY for senior citizens?

Yes, recently the central government has announced that Ayushman Bharat PM-JAY has extended to all senior citizens who are 70 years and above, irrespective of their income levels. This is indeed a good step but for some, it might not be very useful. Some senior citizens feel that they might need extra care and coverage as per their health requirements.

Key Takeaways

  • Getting health insurance for senior citizens is more important than anything else.
  • Ayushman Bharat provides coverage for senior citizens and the sum insured is Rs 5 Lakhs.
  • You will need a separate health insurance plan for senior citizens if you are living in a metropolitan city.

Why do senior citizens need separate health insurance despite PMJAY?

While the Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a commendable initiative to provide health insurance coverage to a large section of the Indian population, senior citizens often require additional health insurance coverage.

Here’s why:

  1. Cost Capping

    The government of India has capped the charges that a hospital can put for any procedure. For example:

    • A caesarian has been capped at Rs 9,000.
    • For knee replacements, it is Rs 9,000 per leg.
    • Bypass surgery is capped at Rs 1.5 lakh.

    However, these services are just double or more when you go to any private hospital. Though the experts are trying to lower the rates of medical services, it is not possible on the ground level.

  2. Increased healthcare needs

    Senior citizens are more prone to chronic diseases like heart ailments, diabetes, arthritis and much more that require ongoing medical care and medications. So, due to their age and health conditions, senior citizens are more likely to require frequent hospitalisations, which can be expensive.

  3. Limited coverage

    PM-JAY provides a substantial sum insured, but it might not be sufficient to cover all the healthcare expenses required by senior citizens, especially in the case of prolonged hospitalisation or expensive treatments. Sometimes, the treatment or conditions might have a waiting period which could delay the coverage for senior citizens who need immediate coverage.

  4. Additional benefits

    You will see that many private health insurance plans offer coverage beyond hospitalisation. They offer cashless treatment, pre-hospitalisation, post-hospitalisation, and home healthcare treatment (a basic need for people above 60) which are not included in the PMJAY scheme.

  5. Rising medical cost

    Healthcare costs are increasing, especially in India with a medical inflation of 14%. In such a scenario, only a senior citizen health insurance plan can offer the best features and benefits for senior citizens and their families.

  6. Financial security

    Senior citizen health insurance plans from private or standalone health insurers are specifically curated to cover every need of old-age ailments and related costs. The Ayushman Bharat Scheme with such a low sum insured of only 5 Lakhs is just not enough for our beloved senior citizens. Though the premiums are higher in the case of private health plans, the cost of healthcare in a medical emergency is well covered saving them out-of-pocket expenses.

  7. Tax Benefits

    In private senior citizens plans, you might have to pay higher premiums. But you can get tax benefits for upto Rs 50,000 under section 80D of the Income Tax Act which is quite higher in the case of private health insurance for senior citizens.

    POV- While PM-JAY is a valuable asset for many, senior citizens should consider supplementing their coverage with a separate health insurance plan to address their specific healthcare needs and financial concerns.

Current scenario for Ayushman Bharat PMJAY

The Ayushman Bharat scheme provides a good backup for your healthcare needs but it cannot be considered a substitute for your own health coverage.

What Works? What Does Not Work?
A comfortable situation for those senior citizens who cannot afford health insurance. A limited network of empanelled hospitals.
People who are dealing with existing ailments are not eligible for the policy. Government hospitals may not be equipped for the elderly with limited mobility.
It might be additional coverage for those who have health policies in place. Only 5 Lakh might not be enough for complex and advanced medical procedures like heart or other major organ surgeries.
Coverage for pre-existing diseases is provided. Need to opt for out-of-pocket expenses if there is any complex procedure like dialysis, etc.
Get free cashless treatment even at private empanelled hospitals (though limited). Choice of premium rooms is not available.
Cover for pre and post-hospitalisation expenses too. Waiting times and queues might be long at Government hospitals and clinics.

In short, you need separate health insurance coverage for senior citizens:

  • To get a higher sum insured.
  • Larger cashless network of hospitals.
  • Option to select a high-end private room.
  • To reduce the waiting time for the admission procedure to the hospital.

Top private health insurance policy for senior citizens

Senior Citizen Plans Sum Insured (Rs.) Entry Age Pre-medical Check-up OPD and Daycare Coverage
Star Senior Citizen Red Carpet 1 to 25 L 60 - 75 Years No All Day Care Treatments
Care Senior Plan 3 to 10 L 61 Years - Lifelong No 540 Day Care Treatments
ManipalCigna Prime Senior 3 to 50 L 56 - 75 Years No mandatory check-up Covered up to the sum insured
Niva Bupa Senior First 5 to 25 L 61 - 75 Years No mandatory check-up Covered up to the sum insured
Aditya Birla Activ Health Platinum Essential 5 L to Depending on the Age 60 Years - Lifelong Depends on medical history 586 Daycare Treatments
Aditya Birla Activ Care 3 to 25 L 55 - 80 Years No 586 daycare procedures covered 586 Daycare Treatments

You can read more here about the senior citizen’s health insurance plans.

Do not ignore the benefits of separate health insurance policies for senior citizens

While the Ayushman Bharat-PMJAY scheme offers significant benefits to a large segment of the Indian population, senior citizens often require additional health insurance coverage to meet their unique healthcare needs. The scheme’s limitations in terms of sum insured, waiting periods, and coverage for certain treatments can leave you vulnerable to substantial out-of-pocket expenses. By considering a separate health insurance plan, senior citizens can ensure financial security, peace of mind, and access to comprehensive healthcare services, ultimately enhancing their quality of life.

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Frequently Asked Questions

1. What are the eligibility criteria for senior citizens to enrol in Ayushman Bharat-PMJAY?

All senior citizens aged 70 and above are eligible, regardless of their income level.

2. Can senior citizens who already have a private health insurance policy still benefit from Ayushman Bharat-PMJAY?

Yes, Ayushman Bharat-PMJAY can be used as a supplementary insurance plan to cover additional expenses.

3. How can senior citizens enroll in Ayushman Bharat-PMJAY?

They can enroll through government health facilities or online portals.

4. How does the claim process work under Ayushman Bharat-PMJAY for senior citizens?

The process involves submitting necessary documents to the empanelled hospital, which will then process the claim with the National Health Authority (NHA).

5. What documents are required for a claim under Ayushman Bharat-PMJAY?

Documents typically include identification proof, address proof, and medical records.

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Simran Saxena

Written By: Simran Saxena

An explorer and a curious person, Simran has worked in the field of insurance for more than 3 years. Traveling and writing is her only passion and hobby. Her main agenda is to transform insurance information into a piece that is easy to understand and solves the reader’s query seamlessly.