Ayushman Bharat PM-JAY

Indian Economy glossary

Also called: AB PM-JAY, PM-JAY, Pradhan Mantri Jan Arogya Yojana · Topic: Human Capital: Education, Health and Demographic Dividend · NCERT: Beyond NCERT

Meaning

Ayushman Bharat PM-JAY (Pradhan Mantri Jan Arogya Yojana) is a health assurance scheme paid for by the government. It covers hospital treatment of up to ₹5 lakh per family per year at empanelled hospitals (hospitals that have signed up to the scheme). The cover is only for secondary and tertiary care hospitalisation, which means admission for specialist or advanced treatment. It is run by the National Health Authority (NHA) under the Ministry of Health and Family Welfare.

It matters because high hospital bills push families into poverty or make them skip treatment. When that happens, people lose health, and with it their ability to work and earn. PM-JAY tries to protect families from this.

Explanation

How it works

  • Ayushman Bharat (2018) has two pillars:
  • Ayushman Arogya Mandirs (renamed from Health and Wellness Centres). These give primary care, such as check-ups, screening and simple treatment close to home.

  • PM-JAY. This pays for hospital treatment of up to ₹5 lakh per family per year.

  • The cover is shared by the whole family. All members draw from one ₹5 lakh limit each year. It is not ₹5 lakh per person.

  • It pays only for hospital admission. It does not pay for outpatient care, meaning doctor visits, tests and medicines without being admitted.
  • It is targeted. The base scheme covers poor and vulnerable households. They are chosen by deprivation criteria, not by age.
  • Who runs it:
  • MoHFW is the ministry in charge.
  • NHA is the implementing agency.
  • Health is a State subject, so the scheme reaches people only in States/UTs that choose to implement it.

Ayushman Vay Vandana: the age-based layer

  • The Union Cabinet approved the change on 11 September 2024. It extends PM-JAY to every citizen aged 70 and above, whatever their income.
  • It was launched on 29 October 2024, along with the Vay Vandana Card.
  • Age is the only test. It is the first universal layer (open to everyone in a group) inside a scheme that is otherwise targeted (only for chosen poor households).
  • It covers about 6 crore senior citizens in about 4.5 crore families.
  • The top-up rule:
  • Some families are already under PM-JAY. Their 70+ members get an extra cover of up to ₹5 lakh a year, for themselves only.
  • Family members below 70 cannot use this extra money.

  • So the elderly member's hospital bills do not use up the rest of the family's cover.

  • The choose-one rule: seniors who already have CGHS, ECHS or CAPF health schemes must pick either their existing scheme or PM-JAY. They cannot use both.

  • Enrolment is on application. Seniors apply through the Ayushman App, beneficiary.nha.gov.in, empanelled hospitals or Common Service Centres.

Worked example: how the top-up protects a family

  • A family of four is under PM-JAY. The grandfather is 72.
  • Family pool: ₹5 lakh a year, shared by all four members.
  • Grandfather's own top-up: another ₹5 lakh a year, for him only.
  • Suppose he needs a ₹3 lakh angioplasty, called PTCA (opening a blocked heart artery):
  • The bill can be paid from his top-up.

  • The family's ₹5 lakh stays fully available for the other three members.

  • Average claim size: ₹5,668.80 crore ÷ 23.46 lakh admissions ≈ ₹24,000 per admission (as on 20 October 2026). Most claims are mid-cost procedures. The big costs come from heart and kidney care.

What makes the cost rise

  • More people enrol and use it. By 31 October 2025, Vay Vandana had 7.89 lakh admissions worth ₹1,741 crore. By 20 October 2026 the running total had reached 23.46 lakh admissions worth ₹5,668.80 crore.
  • Each admission costs more. The average was about ₹22,000 in year one and about ₹25,000 in year two (author's calculation from).
  • The illnesses of old age are expensive and keep coming back. Cataract surgery leads by number (4.71 lakh, about 20.1%). PTCA leads by value (about ₹649 crore). Chronic haemodialysis (regular blood cleaning for kidney failure) is second by number.

In India

  • Institutions:
  • MoHFW is the ministry in charge.
  • NHA implements the scheme.

  • Delhi became the 35th State/UT to implement AB PM-JAY, in April 2025.

  • Policy link: NHP 2017 set a target of public health spending of 2.5% of GDP (by 2025). Government health spending was only about 1.8% of GDP in 2021-22 (National Health Accounts).

  • Out-of-pocket expenditure (OOPE) is the money patients pay from their own pockets:
  • It fell from about 64% of total health spending in 2013-14 to about 39% in 2021-22.

  • It rose back to 43.4% in 2022-23, after 39.4% in 2021-22.

  • Outpatient care was about 38% of current health expenditure in 2021-22, and insurance schemes mostly do not cover it.

  • Budget: the Union allocation for AB PM-JAY in 2026-27 is ₹9,500 crore. This is only 5.56% more than the 2025-26 revised estimate of ₹9,000 crore.
  • Utilisation of Vay Vandana (as on 20 October 2026): 23.46 lakh admissions worth ₹5,668.80 crore.
  • Enrolment gap: about 94.19 lakh Vay Vandana enrolments by 1 December 2025, against about 6 crore eligible.
  • Platform workers: Budget 2025-26 extended AB-PMJAY (₹5 lakh per family per year) to online platform workers registered on e-Shram.
  • Audit findings: CAG Report No. 11 of 2023 (audit period September 2018 to March 2021) found:
  • 1,07,040 pensioners listed as beneficiaries;
  • PM-JAY IDs that were not unique in 1,57,176 approved cases;
  • ₹57.53 crore in excess payments to hospitals in four States;
  • in Andhra Pradesh, 524 of 1,421 empanelled hospitals had submitted zero claims.

Don't confuse with

  • Ayushman Arogya Mandirs. These are the other pillar of Ayushman Bharat and give primary and outpatient care. PM-JAY pays only for hospitalisation (secondary and tertiary care).
  • Ayushman Vay Vandana. It is not a separate scheme. It is an extension of AB PM-JAY for everyone aged 70+, run by the same NHA under MoHFW. The cut-off is 70, not 60 or 65.
  • CGHS / ECHS / CAPF schemes. These are separate health schemes for government employees, ex-servicemen and armed police. A senior in one of them must choose either that scheme or PM-JAY.
  • National Health Authority vs National Health Accounts. Both are shortened to "NHA". The Authority runs PM-JAY. The Accounts are the statistics that measure India's health spending, including OOPE.

Prelims Hooks

  • PM-JAY gives ₹5 lakh per family per year, not per person, and only for secondary and tertiary hospitalisation. Outpatient care is not covered.
  • Implementing agency: National Health Authority, under MoHFW, not the Ministry of Social Justice.
  • Ayushman Vay Vandana: Cabinet approval on 11 September 2024, launch on 29 October 2024. It covers all citizens aged 70+, irrespective of income.
  • The extra ₹5 lakh top-up goes only to the 70+ member, and only in families already under PM-JAY.
  • Cataract leads Vay Vandana claims by number. PTCA leads by value.
  • Delhi was the 35th State/UT to implement AB PM-JAY (April 2025).

Mains Points

  • Targeting vs universalism:
  • The age-only test in Vay Vandana avoids the errors of checking income. CAG found ineligible households and pensioners on the targeted list.
  • But some of the benefit goes to seniors who could pay for themselves.

  • Enrolment by application also favours seniors who are urban and good with phones. Only about 94 lakh of about 6 crore had enrolled by December 2025.

  • Hospital-only cover vs prevention:

  • Outpatient care is about 38% of health spending, and OOPE rose again to 43.4% in 2022-23. So the scheme pays for costly end-stage care such as dialysis, but not for cheap diabetes and blood-pressure control that could prevent it.

  • The Standing Committee recommended adding outpatient consultations, tests and medicines, and raising the family limit to ₹10 lakh. Linking the scheme to Ayushman Arogya Mandirs would also help.

  • Fiscal sustainability and human capital:

  • Claims more than doubled in Vay Vandana's second year, while the PM-JAY budget grew only 5.56% in 2026-27.
  • India is ageing, and the 80+ group is mostly widowed women. Liabilities will keep rising.
  • So the scheme needs better data checks against CGHS/ECHS lists, closer audit of high-value packages like PTCA, and public health spending closer to the NHP 2017 target of 2.5% of GDP.

Read more