Ayushman Bharat (PM-JAY): Free Health Insurance Scheme for Poor and Vulnerable Families in India

By Mr TPM | Updated July 10, 2025

In a major step toward achieving Universal Health Coverage (UHC), the Government of India launched Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) in September 2018. Popularly known as Modicare, this ambitious scheme aims to provide free health insurance coverage of up to ₹5 lakh per family per year to the economically vulnerable sections of society.

Today, PM-JAY stands as the world’s largest government-funded health assurance program, benefiting over 55 crore individuals from 12 crore+ families across India.

What is PM-JAY?

Pradhan Mantri Jan Arogya Yojana (PM-JAY) is a centrally sponsored scheme under the Ayushman Bharat umbrella. It provides cashless hospitalization coverage to eligible beneficiaries for secondary and tertiary care at public and empaneled private hospitals across India.

Beneficiaries can access treatment without paying a single rupee, including surgery, medicines, diagnostics, pre- and post-hospitalization, and ICU care.

Key Features of Ayushman Bharat PM-JAY

• Coverage Amount: ₹5 lakh per family per year
• Coverage Type: Entire family (no cap on family size, age, or gender)
• Mode of Access: Cashless and paperless at point of service
• Treatment Network: Over 25,000 empaneled hospitals (public + private)
• Portability: Benefits available in any state/hospital under the scheme
• Treatment Package: Covers over 1,900 medical procedures

From heart surgeries to cancer care and neonatal treatment, PM-JAY makes life-saving medical care accessible to the poorest of the poor.

Who is Eligible?

Beneficiaries are identified based on Socio-Economic Caste Census (SECC) 2011 data for rural and urban areas.

In rural areas, families qualifying under categories such as:

• Landless laborers
• Families with no adult earning member
• SC/ST households
• Manual scavenger families

In urban areas, eligibility includes:

• Ragpickers
• Domestic workers
• Construction workers
• Street vendors
• Rickshaw pullers, etc.

No registration is required for eligible families. Beneficiaries can check their status using their Aadhaar card, mobile number, or ration card on the PM-JAY official portal or by visiting the nearest Common Service Center (CSC).

Impact So Far

Since its launch, PM-JAY has transformed access to healthcare for millions:

• Over 6 crore hospital admissions worth more than ₹80,000 crore
• More than 50% of treatments availed in private hospitals
• Major reductions in out-of-pocket health expenditure
• Women and elderly among the largest beneficiaries
• States like Uttar Pradesh, Tamil Nadu, Gujarat, and Maharashtra have seen the highest enrollment and utilization

Real-Life Success Stories

Kavita Devi, a resident of Bihar’s Gaya district, shared how the scheme saved her life:
"My heart surgery at a private hospital cost ₹2.3 lakh. We would never have managed that money. Ayushman card took care of it all. I survived because of this scheme."

Mohammed Salim, a rickshaw puller in Delhi, added:
"My wife needed a C-section delivery. I just showed the Ayushman card at the hospital, and everything was covered. We paid nothing."

How to Avail the Benefits?

1. Find a Hospital: Locate an empaneled hospital using the PM-JAY app or website.
2. Visit the Hospital: Approach the Ayushman Mitra desk at the hospital.
3. Verification: Provide Aadhaar or ration card for identity confirmation.
4. Treatment: Cashless treatment is provided once the case is approved.
5. No Hidden Charges: All medical and hospitalization costs are covered under the scheme.

Integration with Other Health Programs

PM-JAY complements several other health initiatives:

• Health & Wellness Centers (HWCs): Focus on preventive and primary healthcare.
• e-Sanjeevani Telemedicine Services: For remote consultation.
• National Digital Health Mission (NDHM): Seamless health records and portability.

Together, these initiatives aim to create a comprehensive health ecosystem, especially for rural and underprivileged populations.

Challenges & The Road Ahead

Despite its success, PM-JAY faces some hurdles:

• Awareness gaps in remote areas
• Quality control in empaneled hospitals
• Fraudulent claims and misuse in certain cases
• Digital literacy barriers in accessing services

To address these, the government is focusing on:

• Better IEC (Information, Education & Communication) campaigns
• Tighter regulation and auditing
• Incentivizing private hospitals in underserved regions

The upcoming Ayushman Bharat Digital Mission (ABDM) is also expected to improve access and accountability through digitization of health data.

Conclusion

Ayushman Bharat PM-JAY has redefined public healthcare in India by shifting from out-of-pocket spending to government-assured health coverage. By placing healthcare within reach of the poor, the scheme not only saves lives but also protects families from slipping into poverty due to medical expenses.

As the scheme evolves with technology and expanded partnerships, it holds the promise of a healthier, more equitable India.