Update on AB-PMJAY

1. At a Glance

• AB-PMJAY is the health-assurance arm of Ayushman Bharat, providing ₹5 lakh/family/year cashless cover for secondary & tertiary hospitalisation; world's largest publicly-funded health insurance scheme [S1][S3].
• Latest PIB update (10 Mar 2026): 43.52 crore Ayushman cards created as on 28.02.2026 [S1].
• Examinable as a flagship welfare scheme touching GS-II (Health/Governance) and GS-III (Inclusive growth, OOP expenditure).

2. Why in the News

• 10 March 2026 Rajya Sabha written reply by MoS Health Shri Prataprao Jadhav: 43.52 crore Ayushman cards issued under AB-PMJAY [S1].
• Earlier expansion (29 Oct 2024): Cabinet approved free ₹5 lakh cover to all citizens aged 70+, irrespective of income — branded Ayushman Vay Vandana card [S2][S4].
• Delhi became the 35th State/UT to implement AB-PMJAY (2025); Odisha had become the 34th earlier [S5][S6].

3. Background & Evolution

• Recommended by National Health Policy 2017; launched by PM Modi on 23 September 2018 at Ranchi, Jharkhand [S3].
• Subsumed earlier Rashtriya Swasthya Bima Yojana (RSBY, 2008) and Senior Citizen Health Insurance Scheme (SCHIS).
• Two pillars of Ayushman Bharat: (i) Health & Wellness Centres / Ayushman Arogya Mandirs, (ii) PM-JAY insurance arm [S3].
• 2024 milestone: Vay Vandana expansion to seniors 70+ regardless of income [S2].

4. Core Static Facts

• Nodal Ministry: Ministry of Health & Family Welfare; implementing body National Health Authority (NHA) at Centre, State Health Agencies (SHA) at State level [S7].
• Cover: ₹5 lakh per family per year, cashless & paperless, portable across India.
• Original beneficiary base: ~10.74 crore poor & vulnerable families (~55 crore individuals) = bottom 40% identified via SECC 2011 (6 rural deprivation + 11 urban occupational criteria) [S7].
• Cards issued: 43.52 crore as on 28.02.2026 [S1].
• Empanelled hospitals: 30,745 (17,084 public + 13,661 private) per recent PIB data [S7].
• Funding share: Centre:State = 60:40 (90:10 for NE & special-category States; 100% for UTs without legislature).
• Senior citizen extension (2024): ~6 crore seniors / 4.5 crore families; existing PMJAY families above 70 get top-up ₹5 lakh exclusive to seniors [S2][S4].
• OOP savings: ₹1.25 lakh crore saved in out-of-pocket expenditure per Economic Survey 2024-25 [S3].

5. Multi-Dimensional Analysis

Economic - Cuts catastrophic health expenditure — a key driver of poverty (≈ 7% pushed below poverty line annually pre-PMJAY). - Crowds-in private hospital capacity in Tier-2/3 towns via empanelment [S7].

Social - Targets bottom 40% via SECC 2011; gender-neutral, no family-size cap, no age cap [S3]. - 2024 expansion universalises cover for 70+ seniors — addresses ageing-population vulnerability [S2].

Administrative / Federal - Opt-in scheme: West Bengal still outside; Delhi (35th) and Odisha (34th) joined recently [S5][S6]. - SHA-led empanelment, package rates set by NHA; portability enabled via Aadhaar-based eKYC.

Ethical / Governance - Concerns of fraudulent claims, ghost beneficiaries, upcoding — CAG (2023) flagged data integrity issues. - NHA's National Anti-Fraud Unit (NAFU) uses AI-based triggers.

Technological - Integrated with Ayushman Bharat Digital Mission (ABDM) — ABHA IDs, Health Claims Exchange (HCX).

6. Recent Developments (last 12-18 months)

• 29 Oct 2024: Cabinet approval for 70+ universal cover (Vay Vandana) [S2].
• 2025: Odisha joins as 34th State [S6]; Delhi joins as 35th State/UT [S5].
• 2025: Enrolment for Ayushman Vay Vandana Cards crosses 25 lakh within months of launch [related PIB].
• 28 Feb 2026: Total Ayushman cards reach 43.52 crore [S1].

7. Prelims Hooks

• Launched on 23 September 2018 at Ranchi, Jharkhand [S3].
• Nodal implementing agency: National Health Authority under MoHFW [S7].
• Cover: ₹5 lakh per family per year, no cap on family size/age [S3].
• Beneficiary identification basis: SECC 2011 (6 rural deprivation + 11 urban occupational criteria) [S7].
• Funding ratio: 60:40 (90:10 NE/special category).
• Cards issued as on 28.02.2026: 43.52 crore [S1].
• Empanelled hospitals: 30,745 (17,084 public + 13,661 private) [S7].
• Delhi = 35th State/UT to implement AB-PMJAY [S5]; Odisha = 34th [S6].
• Ayushman Vay Vandana Card: for all citizens aged 70+ irrespective of income, approved 29 Oct 2024 [S2].
• Top-up of ₹5 lakh exclusive to seniors in already-enrolled PMJAY families [S2].
• Estimated senior-citizen beneficiaries: ~6 crore individuals / 4.5 crore families [S2].
• AB-PMJAY is the insurance pillar; the other pillar is Ayushman Arogya Mandirs (renamed HWCs).
• Predecessor scheme it subsumed: RSBY (2008).

8. Mains Relevance

• GS-II: Welfare schemes for vulnerable sections; Issues relating to development and management of Social Sector/Services – Health.
• GS-III: Inclusive growth; Government Budgeting (health expenditure).
• Possible question stems: 1. "Examine how the 2024 expansion of AB-PMJAY to senior citizens above 70 addresses the challenges of an ageing India." (GS-II, 15M) 2. "AB-PMJAY has reduced catastrophic out-of-pocket health expenditure but raises concerns of moral hazard and fraud. Discuss." (GS-II, 10M) 3. "Evaluate the federal challenges in universalising AB-PMJAY across all States." (GS-II, 15M)

9. Related Topics to Study Next

• Ayushman Bharat Digital Mission (ABDM) — digital backbone (ABHA ID, HCX).
• Ayushman Arogya Mandirs (erstwhile HWCs) — preventive/primary care pillar.
• National Health Policy 2017 — parent policy framework.
• Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) — affordable generics complement.
• PM-ABHIM (PM Ayushman Bharat Health Infrastructure Mission) — supply-side investment.
• National Health Authority — institutional setup, contrast with IRDAI.
• SECC 2011 — beneficiary identification basis across welfare schemes.
• Economic Survey 2024-25 — Health chapter — OOP, health expenditure as % of GDP.

10. Common Errors / Trap Areas

• Cover is per family, not per individual (except the new Vay Vandana top-up for seniors which is per-senior).
• PMJAY ≠ entire Ayushman Bharat; AB has TWO pillars — Arogya Mandirs (primary) + PMJAY (secondary/tertiary).
• Nodal authority is National Health Authority (NHA), NOT IRDAI or NITI Aayog.
• Beneficiary list from SECC 2011, not Census 2011.
• West Bengal has NOT implemented PMJAY; assume "all-India" only with caveat. Delhi joined as the 35th in 2025 [S5].
• 70+ universal cover started 29 Oct 2024, not at original 2018 launch [S2].

11. Sources

• [S1] Update on AB-PMJAY (PRID 2237404), PIB, 10 Mar 2026 — https://www.pib.gov.in/PressReleasePage.aspx?PRID=2237404 — (tier 1)
• [S2] Cabinet approves health coverage to all senior citizens 70+ under AB PM-JAY (PRID 2053883), PIB — https://www.pib.gov.in/PressReleasePage.aspx?PRID=2053883 — (tier 1)
• [S3] Ayushman Bharat PMJAY (PRID 1738169), PIB — https://www.pib.gov.in/PressReleasePage.aspx?PRID=1738169 — (tier 1)
• [S4] Update on Ayushman Vay Vandana Yojana (PRID 2203007), PIB — https://www.pib.gov.in/PressReleasePage.aspx?PRID=2203007 — (tier 1)
• [S5] Delhi becomes 35th State/UT to implement AB-PMJAY (PRID 2119281), PIB — https://www.pib.gov.in/PressReleasePage.aspx?PRID=2119281 — (tier 1)
• [S6] Odisha becomes 34th State to implement AB-PMJAY (PRID 2092541), PIB — https://www.pib.gov.in/PressReleasePage.aspx?PRID=2092541 — (tier 1)
• [S7] Steps to Strengthen Healthcare access under AB-PMJAY (PRID 2099547), PIB — https://www.pib.gov.in/PressReleaseIframePage.aspx?PRID=2099547 — (tier 1)