In post-pandemic India, the significance of the Ayushman Bharat Scheme, colloquially referred to as Pradhan Mantri Health Insurance, has grown due to the dire need for healthcare access, especially for senior citizens who often face multiple comorbidities and financial challenges. All sections of society demand equitable access to healthcare and interventions. The Ayushman Bharat Scheme aims to make healthcare more accessible and ‘affordable’ for the people of India, with a special focus on senior citizens, one of the most vulnerable groups. This guide explores the Ayushman Bharat Scheme in the context of senior citizens, including its use in hospitals, covered ailments, common issues, grievance redressal mechanisms, and FAQs.

The Ayushman Bharat Scheme for Senior Citizens 

India’s growing elderly population deserves reliable and affordable medical care. Acknowledging this need, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has expanded to include all senior citizens aged 70 and above, regardless of income. Senior citizens, often dependent on their savings, are as vulnerable to crippling healthcare expenses as the poorest sections of society. Factors like advanced age, pre-existing health conditions, and the rising cost of private health insurance make this inclusion even more critical. Let’s explore how senior citizens can benefit from this scheme—covering eligibility, enrollment, using the card in hospitals, common challenges, and assistance options when issues arise.

Eligibility Criteria for Senior Citizens under the Ayushman Bharat Scheme 

To avail the benefits of the Ayushman Bharat Scheme as a senior citizen, certain criteria must be met. The primary eligibility requirement is age—applicants must be 70 years or older. Unlike other health insurance schemes, this program has no income-based restrictions, making it accessible to a broader segment of the elderly population. Additionally, even senior citizens not listed in the Socio-Economic Caste Census (SECC) database are eligible. However, being an Indian citizen is a mandatory requirement to qualify for this scheme.

Admission Procedure for Ayushman Bharat  

Senior citizens can follow these simple steps to enroll:

Document Checklist: 

1. Aadhaar Card (mandatory)
2. Proof of age
3. Proof of address (Ration Card, Voter ID, Utility Bills etc.)
4. Passport-size photo

Where to Enroll: 

1. Go to your closest Common Service Center (CSC)
2. Visit an empanelled hospital with an Ayushman Mitra.
3. Register online using https://beneficiary.nha.gov.in

Get Verified: 

Age will be verified using your Aadhaar card. Verification is completed through biometrics or an OTP-based e-KYC process.

Ayushman Card Generation: 

Once verification is complete, you will receive a golden card—your access pass for cashless treatments.

Utilizing the Ayushman Bharat scheme 

After enrollment, senior citizens can use the Ayushman Bharat card at a wide network of empanelled hospitals. This card provides cashless access to a variety of medical services and treatments under the scheme. Beneficiaries should be aware of potential challenges like verification delays or hospital refusals and know how to handle them. Grievance redressal options are available to ensure a smooth experience.

Guidelines for Using the Scheme in Hospitals 

1. Find an Empaneled Hospital:
2. Go with Ayushman Bharat app or https://hospitals.pmjay.gov.in to search for the nearest empanelled government or private hospitals.
3. Visit the Hospital
4. Please carry your Ayushman card and Aadhaar.
5. Try to approach the Ayushman Mitra desk set up in the hospital for the right guidance.

Pre-Authorization and Package Selection: Your ailment will be categorized under predefined treatment packages, and the hospital will request pre-authorization from the insurer or Third-Party Administrator (TPA).

Get Treated: Once approved, you are entitled to cashless treatment for services covered up to ₹5 lakh annually. This includes diagnostics, surgery, pre- and post-treatment medication, and more. 

Post-Treatment Documentation: Submit final papers to recover the cost from NHA/insurer (hospital).

Common Problems Encountered and what to do  

• Hospital Denials of Treatment or “Not Covered” 

Cause: Non-empanelled hospitals, unfamiliarity with the scheme, or reluctance to process claims.

What to do: 

1. Kindly demand that you be connected to the Ayushman Mitra.)
2. Immediately call the Ayushman Bharat Helpline (14555).
3. Give grievance through the NHA portal.

•  Card Not Found in the System 

Can happen because of registration errors or technical glitches.

1. Confirm information at https://beneficiary.nha.gov.in.
2. Have your card verified or re-issued at your CSC.

• Partial Billing or Requests for Cash Payment 

1. Illegal under the scheme.
2. Immediately report to the hospital nodal officer or Ayushman Mitra.

1. iv) Lack of Awareness at hospital desk 

1. Carry printouts or screenshots of your eligibility or the senior citizen policy FAQ.
2. Ask them to escalate to the hospital empanelment coordinator.

Grievance Redressal and Helpline Details 

If you have any problems, or want to report misconduct, here are the formal channels:

1. 24×7 Helpline Number: 14555 or 1800-111-565
2. Email Support: [email protected]
3. The grievance portal: https://grievance.nha.gov.in
4. State Helpline Numbers: Varies by state; visit https://pmjay.gov.in