In News:

Odisha has become the 34th state to implement the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). The National Health Authority (NHA) of the Union Ministry of Health signed a Memorandum of Understanding (MoU) with the Department of Health and Family Welfare, Government of Odisha to onboard the state under the scheme.

Key Highlights:

• The scheme will be implemented alongside the existing Gopabandhu Jan Arogya Yojana in Odisha.
• It provides health coverage of Rs. 5 lakh per family per annum, with an additional Rs. 5 lakh for women members.
• Approximately 1.03 crore families will be covered under the scheme.
• Shri JP Nadda, Union Health Minister, emphasized that the scheme is the world’s largest and fastest-growing health coverage initiative.
• Shri Mohan Charan Majhi, Chief Minister of Odisha, highlighted that people will now have access to cashless treatment in over 29,000 empaneled hospitals.

About Ayushman Bharat PM-JAY:

• Launched in 2018 under the Ministry of Health & Family Welfare (MoH&FW).
• Targets 12 crore families (~55 crore beneficiaries).
• Provides cashless hospital coverage for secondary and tertiary care.
• Fully funded by the government, with cost-sharing between the Centre and states.
• Covers nearly 2,000 medical procedures, including major surgeries.

Since its inception, over 8.19 crore hospital admissions have been recorded, with ?1.13 lakh crore spent on healthcare for marginalized sections.

In News:

• The Union Cabinet has approved a major expansion of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to cover all senior citizens aged 70 years and above.
• This change allows anyone in this age group to be eligible for health insurance, regardless of their income level.
• This expansion aims to address the healthcare needs of the elderly, who often face higher medical expenses as they age.
• By lifting income restrictions, the government is ensuring that more senior citizens can benefit from much-needed health coverage, which will help ease the financial burden of healthcare.

How does the scheme work?

• The AB PM-JAY now covers an additional 6 crore individuals from 4.5 crore families, focusing on seniors aged 70 and above. Each senior citizen will be given a health card, allowing them easy access to healthcare services under the scheme.
• The scheme provides Rs 5 lakh coverage annually per family. If there are multiple senior citizens in the same family, this coverage is shared among them. The scheme is particularly beneficial for nuclear families, where the financial burden on elderly members can be more difficult to manage.

Key details of the scheme for senior citizens above 70

• Eligibility - All senior citizens aged 70 and above are eligible for Rs 5 lakh health coverage, regardless of income or social status.
• Top-up coverage - For families already enrolled in Ayushman Bharat, senior members will receive an extra Rs 5 lakh top-up, which is solely for their use.
• Private insurance - Senior citizens with private health insurance can still take advantage of the scheme without any conflict with their existing coverage.
• Public health schemes - Seniors who are part of other public health schemes like the Central Government Health Scheme (CGHS), Ex-Servicemen Contributory Health Scheme (ECHS), or Ayushman Central Armed Police Force (CAPF) will need to choose between their current insurance and the new Ayushman Bharat health coverage.
• New health cards - All eligible senior citizens will receive a separate health card, which will help them access the scheme’s benefits more efficiently.

Who pays for the coverage?

• The cost of this expanded coverage will be Rs 3,437 crore initially. State governments will bear 40% of the expenses, while the Centre will cover the remaining 60%. For states in hilly and northeastern regions, the Centre will fund 90% of the costs.
• As more senior citizens enrol, the costs may increase. Experts point out that covering elderly individuals often costs more than providing insurance for younger, economically weaker sections of society. However, the government is prepared to scale up the coverage based on demand.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY)

• AB PM-JAY launched in 2018, is a flagship program designed to offer affordable and accessible healthcare to millions of vulnerable families across India.
• The primary aim is to provide health insurance coverage up to ?5 lakhs per family annually for secondary and tertiary care hospitalization.
• The scheme currently supports 55 crore individuals from 12.34 crore families throughout the country.