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 program launched by the Government of India in 2018 for the bottom 40% of the Indian population. Know more about Ayushman Bharat-PMJAY. It gives coverage of ₹5 Lakhs, which is quite good but not enough in the case of senior citizens.
Update
Prime Minister Narendra Modi has launched health coverage for all citizens aged 70 years and above under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) on Tuesday, October 29, 2024. The scheme is expected to benefit 60 million Indian citizens in approximately 45 million households. Under the scheme, those who avail of the Ayushman card can receive free treatment up to ₹5 lakhs at any of the AB-PMJAY empanelled hospitals from October 29, 2024, onwards.
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, according to their Aadhaar card, irrespective of their income levels. You need to register with the Ayushman Bharat Vay Vandana Card that will be linked to your Aadhaar card. Beneficiaries can avail of treatment from the very first day of enrollment. There’s no waiting period for any disease or treatment, ensuring immediate coverage. Importantly, there’s no income limit for eligibility.
Ayushman Bharat’s recently added features can be beneficial for the seniors of our society. But, for many, the coverage might not be sufficient. As seniors, they need health insurance policies with a higher sum insured and greater benefits. To combat this issue, we have handpicked some of the best senior citizen health insurance to meet all your needs!
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 ₹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:
Cost Capping
The Government of India has capped the charges that a hospital can levy for any procedure. For example:
- A caesarean has been capped at ₹9,000.
- For knee replacements, it is ₹9,000 per leg.
- Bypass surgery is capped at ₹1.5 lakh.
However, these services often cost double or more in private hospitals. While experts are trying to lower medical service rates, this is not always feasible at the ground level.
Increased Healthcare Needs
Senior citizens are more prone to chronic diseases like heart ailments, diabetes, arthritis, and many more that require ongoing medical care and medications. Due to their age and health conditions, senior citizens are more likely to require frequent hospitalizations, which can be expensive.
Limited Coverage
PM-JAY provides a substantial sum insured, but it might not be sufficient to cover all healthcare expenses required by senior citizens, especially in cases of prolonged hospitalization or expensive treatments. Sometimes, treatments or conditions may have a waiting period, which can delay coverage for senior citizens who need immediate care.
Additional Benefits
Many private health insurance plans offer benefits beyond hospitalization. These include cashless treatment, pre-hospitalization, post-hospitalization, and home healthcare (a crucial need for those above 60), which are not typically included in the PMJAY scheme.
Rising Medical Costs
Healthcare costs are increasing, especially in India, with medical inflation at 14%. Given this, a dedicated senior citizen health insurance plan can provide comprehensive features and benefits for seniors and their families.
Financial Security
Senior citizen health insurance plans from private or standalone health insurers are specifically curated to cover the needs of old-age ailments and related costs. With a sum insured of only ₹5 Lakhs, the Ayushman Bharat Scheme may not be sufficient for all the healthcare needs of senior citizens. Although premiums are higher for private health plans, they provide comprehensive coverage for medical emergencies, saving out-of-pocket expenses.
Tax Benefits
While private senior citizen plans may have higher premiums, you can avail tax benefits up to ₹50,000 under Section 80D of the Income Tax Act, which is a significant advantage for private health insurance for senior citizens.
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 senior citizens who cannot afford health insurance. | A limited network of empanelled hospitals. |
| Coverage for pre-existing diseases is provided from day one. | Government hospitals may not be equipped for the elderly with limited mobility. |
| It can be additional coverage for those who already have health policies. | Only ₹5 Lakhs might not be enough for complex and advanced medical procedures like heart or other major organ surgeries. |
| Get free cashless treatment even at private empanelled hospitals (though limited). | Need to opt for out-of-pocket expenses if there is any complex procedure like dialysis, etc. |
| Cover for pre and post-hospitalization expenses. | Choice of premium rooms is not available. |
| 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 Policies 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 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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