Ayushman Bharat PM-JAY
Health cover of Rs 5 lakh per family per year for hospital care.
Written by Pratidin; every fact checked by a separate review before publishing. How we work
Ministry of Health and Family Welfare. Covers secondary and tertiary hospitalisation.
Quick recall
- How much cover does PM-JAY give?
- ₹5 lakh per family per year.
- When was it launched?
- 23 September 2018.
- What care does it cover?
- Secondary and tertiary hospitalisation.
- How were beneficiaries identified?
- Using SECC 2011 deprivation criteria, later expanded.
- Which age group got universal cover in 2024?
- Everyone aged 70 and above.
- Which body implements it?
- The National Health Authority.
Asked before in UPSC
Recurring theme: Universal health coverage and public versus private healthcare
Balance PM-JAY's insurance route with Health and Wellness Centres (Ayushman Arogya Mandirs), the other pillar of Ayushman Bharat.
Ayushman Bharat pairs PM-JAY secondary and tertiary cover with a primary care push; critics say insurance cannot substitute primary care.
Neglect of primary health care and education in India are reasons for its backwardness
Out-of-pocket health spending and catastrophic expenditure, which PM-JAY targets, are strong essay material.
Use the Ayushman Bharat architecture announced in 2018: community-level wellness centres plus PM-JAY hospital cover.
PM-JAY is the government-funded insurance model that buys hospital care from empanelled private and public hospitals.
Tests the curative bias and State role that frame PM-JAY's hospital-care focus and Centre-State cost sharing.
ABDM is the digital layer of the Ayushman Bharat umbrella; portability also applies to PM-JAY entitlements.
The basics
Why it matters
Ayushman Bharat PM-JAY provides health cover of ₹5 lakh per family per year for secondary and tertiary hospital care. Launched in 2018, it is one of the world's largest government health insurance schemes.
Two pillars of Ayushman Bharat
The programme has two parts.
- 1PM-JAYHospital insurance for poor families
- 2Health and Wellness CentresNow Ayushman Arogya Mandirs, primary care
- 3CashlessAt empanelled hospitals
- 4PortableAcross India
You now know
- Launched on 23 September 2018.
- ₹5 lakh cover per family per year for hospitalisation.
- Beneficiaries identified from SECC 2011 data, later expanded.
- Extended in 2024 to all citizens aged 70 and above.
Go deeper
In one line: PM-JAY protects poor families from hospital bills that push them into poverty.
Why it matters for UPSC
Health financing and Out-of-pocket expenditure are frequent GS2 themes.
The core idea
Insurance spreads the risk of expensive hospital care. But it depends on Health and Wellness Centres and public hospitals to keep people healthy.
Where to go next
- Out-of-pocket expenditure: What families pay from their own pockets
- Health and Wellness Centres: Primary care close to home
In one line: Insurance helps with hospital costs, but most health spending is on outpatient care and medicines.
Issues
Low package rates, uneven private hospital participation, fraud and weak coverage of outpatient costs.
Balance
Health and Wellness Centres reduce the need for hospitalisation; reducing Out-of-pocket expenditure needs both.
Where to go next
- Out-of-pocket expenditure: What families pay from their own pockets
- Health and Wellness Centres: Primary care close to home
Out-of-pocket expenditure
What families pay from their own pockets
In one line: Out-of-pocket expenditure is health spending paid directly by households.
Trend
National Health Accounts show its share of total health spending falling in recent years.
Why it matters
High out-of-pocket costs push families into poverty.
Where to go next
- Health and Wellness Centres: Primary care close to home
Health and Wellness Centres
Primary care close to home
In one line: Health and Wellness Centres, renamed Ayushman Arogya Mandirs, provide comprehensive primary care.
Services
Maternal and child health, non-communicable disease screening and free medicines.
Aim
Care close to home to prevent costly hospitalisation.
Where to go next
- Out-of-pocket expenditure: What families pay from their own pockets
Prelims-style quiz
PM-JAY provides annual cover of:
- ₹5 lakh
- ₹1 lakh
- ₹10 lakh
- ₹2 lakh
Show answer
Answer: (a) ₹5 lakh. ₹5 lakh per family.
Consider the following:
1. PM-JAY covers outpatient care.
2. It is portable across States.
Which of the statements given above is/are correct?- 1 only
- 2 only
- Both 1 and 2
- Neither 1 nor 2
Show answer
Answer: (b) 2 only. It covers hospitalisation, not routine outpatient care.
PM-JAY is implemented by the:
- ICMR
- NITI Aayog
- National Health Authority
- IRDAI
Show answer
Answer: (c) National Health Authority. The National Health Authority.
In 2024, PM-JAY was extended to all citizens aged:
- 60 and above
- 70 and above
- 65 and above
- 75 and above
Show answer
Answer: (b) 70 and above. 70 and above.