Budget 2023 | Ayushman Bharat may cater to India's missing middle - Report

AB PM-JAY was launched in September 2018 to provide free health cover of up to Rs 5 lakh to around 107.4 million poor and vulnerable families and now covers over 140 million families comprising approximately 720 million individuals, protecting 60 percent of the population.

An additional 250 million, or approximately 10 percent, have some form of private health insurance, leaving about 400 million, or 30 percent of the population, out of the ambit of any health scheme, according to a NITI Aayog report published in October 2021.

The Niti Aayog report defined the missing middle as those not poor or vulnerable enough to qualify for public-funded health insurance schemes but not wealthy enough to purchase private plans either. However, this segment remains equally vulnerable to sudden healthcare expenses.

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A World Bank report last year said that out-of-pocket healthcare payments had pushed more than half-a-billion people into extreme poverty.

However, under the scheme, all beneficiaries can immediately avail of the treatment, even for pre-existing conditions. This is not the case with the majority of private insurance policies. Hence, the early enrolments may largely come from those already in need of healthcare, boosting the scheme’s utilisation without enough premium payers and raising financial risks to the scheme, the report said.

A spokesperson told Mint that under the new plan for the missing middle, the health package rate would be different in comparison to the existing package rate. The beneficiary would be able to avail of the benefits of the general ward, semi-private ward and private ward as per their package plan.