Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-
PMJAY): In Quest of Providing Accessible, Affordable & Quality
Solutions to Achieve Universal Healthcare
Dr. Taruna Juneja Gandhi, Dr. Nishant Sagar
BITS, Pilani
Received: 06 December 2025; Accepted: 11 December 2025; Published: 20 December 2025
ABSTRACT
Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana is a flagship scheme of the Government of India, with a
vision of Universal Health Coverage (UHC) as its underlying commitment of "leaving no one behind." Launched
in 2018, AB-PMJAY is the world’s largest health assurance scheme, aiming at providing a health cover for
secondary and tertiary care hospitalization to over 12 crores poor and vulnerable families. With more than 42.7
crore Ayushman cards created across the country, and 32,500 empanelled hospitals, the AB-PMJAY scheme is
currently providing cashless healthcare services for 1,961 procedures across 27 medical specialities. AB-PMJAY
scheme has been evolving since its inception and is constantly adding new features in its portfolio, such as
coverage of 70+ population; shift from volume-based to value-based care system, strengthening of district
implementation units, to name a few. The scheme has many achievements, however, there are gaps and
irregularities in the current disposition. The article outlines these gaps and gives pragmatic solutions to fill those
loopholes. Filling these critical gaps is critical before the programme goes on to the next level, in terms of
coverage without compromising on the quality of care.
Keywords: Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Out-of-Pocket expenditure
(OOPE), Accessibility of healthcare services, health insurance
Current Policy Scenario
Launched in 2018, Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) aimed to reduce Out-
of-Pocket expenditure (OOPE), and improve affordability of healthcare services, especially secondary and
tertiary care to the poor and vulnerable sections of the population. The schemes encouraged the inclusion and
utilization of the Private Sector to improve accessibility and quality of healthcare for the vulnerable population.
The policy aspired to solve multiple systemic issues in India’s healthcare system, such as fragmented insurance
coverage across states, weak financial protection for acute & chronic illnesses and reduce catastrophic
expenditure on healthcare services.
A health insurance cover of 5 lakhs per family per year for secondary and tertiary care hospitalization to over
10.741 crore families from the poor and vulnerable section of the population (based on SECC, 2011) was offered.
The eligible families are given cashless and paperless access to healthcare services at the empanelled hospitals,
be it public or private. More recently, in 2024, senior citizens aged above 70 years, irrespective of their
socioeconomic status, have also been made eligible to avail the benefits of AB-PMJAY.
AB-PMJAY provides seamless and portable health insurance across the country with no age bar and capping on
family size. All the preexisting conditions are covered along with additional benefits such as coverage of the cost
of diagnostics and medicines for up to 3 days pre-hospitalization and 15 days post-hospitalizationi. The scheme
dared to include various health insurance schemes such as Rashtriya Swasthya Bima Yojana (RSBY), Central
Government Health Scheme (CGHS), Employees’ State Insurance Scheme (ESIS) and state-funded extension
schemes – with different coverage and varying benefits. Since the launch, the scheme has been constantly
revising the Health Benefit Packages (HBPs) and setting appropriate reimbursement rates on an annual basisii.
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