Age-based universalism in Ayushman Vay Vandana marks a departure from the targeted design of AB PM-JAY. Examine the merits and fiscal risks of this shift.

In September 2024, the Union Cabinet extended AB PM-JAY's ₹5 lakh hospital cover to every citizen aged 70+, irrespective of income [1]. Age replaces deprivation as the test of eligibility for about 6 crore seniors. This brings real gains in inclusion but also creates an open-ended fiscal liability.

Merits of the shift

• Fewer exclusion and inclusion errors: age is easier to verify than poverty. CAG Report No. 11 of 2023 found ineligible households and 1,07,040 pensioners on the targeted PM-JAY list [2].
• Reaches the "missing middle": it covers elderly people who are neither poor enough for targeted lists nor insured. Households' out-of-pocket spending rose back to 43.4% of total health expenditure in 2022-23 [3].
• Protection from catastrophic costs: 23.46 lakh admissions worth ₹5,668.80 crore were authorised in two years. Cardiac angioplasty (PTCA) leads by value [4].
• Careful design: a separate ₹5 lakh top-up for seniors in existing PM-JAY families keeps their claims from using up the rest of the family's cover. CGHS/ECHS/CAPF members must choose one scheme, which prevents double coverage [1].

Fiscal risks

• Entitlement outpaces budget: the PM-JAY allocation for 2026-27 is ₹9,500 crore, only 5.56% above the 2025-26 revised estimate [5]. Vay Vandana claims are growing far faster.
• Hidden future liability: only about 94 lakh seniors had enrolled by December 2025, against about 6 crore eligible [6]. Every new enrolment adds future claims.
• Recurring, costly care: chronic haemodialysis is second by volume [4]. It is a lifelong cost, not a single hospital stay, and the hospital-only design pays for end-stage disease rather than cheaper prevention.
• Deadweight and leakage: some of the subsidy goes to seniors who could pay. CAG also found non-unique IDs in about 1.57 lakh cases and ₹57.53 crore in excess payments to hospitals [2]. High-value packages carry the greatest risk.

Age-based universalism accepts some spending on seniors who could pay in return for broad inclusion and simpler administration. To make it sustainable, NHA should match its lists against pensioner databases, audit high-value claims, and link the card to screening and chronic-disease care at Ayushman Arogya Mandirs. With these fixes, the shift would advance Article 41's promise of public assistance in old age and SDG 3.8 on universal health coverage.