Pradhan Mantri Jan Arogya Yojana (PMJAY)

Overview

Pradhan Mantri Jan Arogya Yojana (PMJAY), also known as Ayushman Bharat — the world’s largest government-funded health insurance scheme — was launched on 23 September 2018 from Ranchi, Jharkhand. It is a Centrally Sponsored Scheme that provides health insurance coverage of Rs. 5 lakh per family per year for secondary and tertiary care hospitalisation to the bottom 40% of India’s population. It subsumed the earlier Rashtriya Swasthya Bima Yojana (RSBY) and Senior Citizen Health Insurance Scheme (SCHIS).

As of 28 February 2026, the scheme has created 43.52 crore Ayushman cards, authorised 11.69 crore hospital admissions worth Rs. 1.73 lakh crore, and empanelled 36,229 hospitals across India. The Union Budget 2025-26 allocated Rs. 9,406 crore to PMJAY — a 29% increase over the previous year. The scheme has saved beneficiaries over Rs. 1.52 lakh crore in out-of-pocket healthcare expenditure.

Coverage and Benefits

What is Covered

• Secondary care: General medicine, general surgery, obstetrics & gynaecology, orthopaedics, ophthalmology, ENT
• Tertiary care: Cardiology, nephrology, oncology, neurosurgery, organ transplants
• Pre-hospitalisation: Up to 3 days before admission (diagnostics, consultations)
• Post-hospitalisation: Up to 15 days after discharge (follow-up, medication)
• Over 1,929 treatment packages covering medical, surgical, and day-care procedures

Who is Eligible

• Families identified through SECC 2011 data (rural: 7 deprivation criteria; urban: 11 occupational categories)
• No cap on family size — all members of an eligible family are covered
• No restriction on age, gender, or pre-existing conditions
• Portability — beneficiaries can access services at any empanelled hospital across India

Implementing Bodies

• National Health Authority (NHA): Autonomous entity under Society Registration Act, 1860; overall programme management at the national level
• State Health Agency (SHA): Implements PMJAY at the state level; manages empanelment, claims processing, and grievance redressal
• Pradhan Mantri Arogya Mitras (PMAMs): Stationed at every empanelled hospital to assist beneficiaries with verification, admission, and discharge

Expansion for Senior Citizens (September 2024)

The government expanded PMJAY on 29 October 2024 to cover all senior citizens aged 70 years and above, irrespective of socio-economic status:

• Covers approximately 6 crore senior citizens from 4.5 crore families
• Rs. 5 lakh annual health insurance per senior citizen
• Separate Ayushman Vay Vandana cards issued (1.14 crore cards issued by February 2026)
• Existing PMJAY beneficiaries aged 70+ get an additional Rs. 5 lakh top-up over their family entitlement
• Beneficiaries can choose between CGHS, ECHS, Ayushman CAPF, or AB-PMJAY

Expansion to Gig Workers (Budget 2025-26)

The Union Budget 2025-26 announced extension of PMJAY coverage to approximately 1 crore gig workers:

• Gig workers to be identified through unique identity cards and registered on the e-Shram portal
• Coverage of Rs. 5 lakh per family per year for cashless hospitalisation
• India’s gig economy estimated at 7.7 million workers (2020-21), projected to reach 23.5 million by 2029-30 (NITI Aayog)

Expansion to Health Workers (March 2024)

In March 2024, eligibility was expanded to include 37 lakh ASHAs, Anganwadi Workers (AWWs), Anganwadi Helpers (AWHs), and their families under PMJAY.

Latest Developments

• February 2026: 43.52 crore cards issued; 11.69 crore hospital admissions worth Rs. 1.73 lakh crore authorised; FY27 target set at 3 crore admissions and Rs. 36,000 crore claims
• Union Budget 2025-26: Allocation of Rs. 9,406 crore (29% increase); PMJAY extended to 1 crore gig workers
• October 2025: Scheme declared world’s largest healthcare scheme, covering 12 crore families, saving Rs. 1.52 lakh crore in out-of-pocket costs
• October 2024: Ayushman Vay Vandana launched for all senior citizens aged 70+
• March 2024: 37 lakh ASHAs, AWWs, AWHs and their families added to PMJAY coverage
• PMABHIM (PM Ayushman Bharat Health Infrastructure Mission): Allocated Rs. 4,200 crore in FY 2025-26 (40% increase) for health infrastructure strengthening

Prelims Importance

• PMJAY launched 23 September 2018 from Ranchi, Jharkhand
• Coverage: Rs. 5 lakh per family per year; no cap on family size
• Subsumed RSBY and SCHIS
• Beneficiary identification: SECC 2011 data
• NHA is an autonomous entity under Society Registration Act, 1860
• 43.52 crore cards issued; 36,229 hospitals empanelled (as of February 2026)
• Budget FY 2025-26: Rs. 9,406 crore (29% increase)
• Ayushman Vay Vandana: for all citizens aged 70+ irrespective of income (October 2024)
• Gig worker extension announced in Union Budget 2025-26
• 1,929+ treatment packages covered
• Portability across all states — no domicile restriction

Mains & Interview Importance

GS Paper 2 — Health, Governance, Social Justice

• Critically evaluate the performance of PMJAY in achieving universal health coverage. How has the scheme addressed the challenge of catastrophic health expenditure among India’s poorest households?
• Discuss the role of public-private partnership in PMJAY’s hospital empanelment model. What are the challenges of quality assurance and fraud prevention?

GS Paper 3 — Economy

• Analyse the fiscal sustainability of PMJAY given its expanding coverage (senior citizens, gig workers, health workers). What revenue model can sustain the scheme long-term?

Interview Angle

• “PMJAY has issued 43 crore cards but authorised only 11.69 crore admissions. Is this a sign of low awareness, supply-side constraints, or both? What would you recommend to improve utilisation?”