Ayushman Bharat Vaya Vandana: Is Rs 5-lakh govt-backed health coverage good enough for senior citizens over 70?

Ayushman Bharat Vaya Vandana: Why the elderly might still need an individual health insurance cover

With Prime Minister Narendra Modi officially launching the Ayushman Bharat Vaya Vandana scheme for senior citizens over the age of 70 years — irrespective of their income level —the government-backed health coverage of up to Rs 5 lakh is now available for this age group.

Senior citizens from economically-weaker sections who were already covered under Ayushman Bharat-PM-JAY (Jan Aarogya Yojana) as part of health assurance meant for families will get an additional coverage of Rs 5 lakh.

The National Health Authority (NHA) has enabled the process of registering for this scheme and obtaining an Ayushman Bharat 'Vaya Vandana' card through the beneficiary portal (beneficiary.nha. gov.in) or NHA’s Ayushman app. Senior citizens or their family members can also complete the process at PM-JAY empanelled hospitals and common services centres. “It is likely that registration and creation of the card will be facilitated even at the time of hospitalisation in case the beneficiary is unable to complete the process in advance. Other procedures and systems will remain the same, as the government has not come up with any new, specific set of guidelines for treatment of such senior citizens,” said an insurance executive who spoke on the condition of anonymity.

Also read: Ayushman Bharat scheme: Why senior citizens over 70 need separate health insurance covers despite PM-JAY

Relief for senior citizens with pre-existing diseases

This scheme will act as a source of comfort for senior citizens who may not be able to afford treatment at hospitals or even health insurance premiums, which are linked to age, among other conditions. It will also offer solace to senior citizens who have pre-existing health conditions such as diabetes or hypertension. Besides age, existing illnesses, too, can push up health insurance premiums; depending on the severity, and insurance companies may even refuse to issue policies.

Those who already have health insurance policies will not be excluded from this scheme's purview. This means that even those who have a health policy will have access to a larger cover, which can come in handy if their insurance sum is exhausted during the year.

The hurdles: restricted choice of doctors, hospitals and room type

While the government has extended Ayushman Bharat-PM-JAY scheme coverage to all those over the age of 70 years — their income levels notwithstanding — not all senior citizens will find this scheme useful. Those belonging to higher income groups are more likely to treat it as a back-up, rather than a substitute for independent health insurance policies.

This is because the coverage will be effective only at empanelled hospitals, including government and select private facilities, where the treatment rates are frozen. For elderly individuals who may have been consulting, say, their cardiologist or general physician for years, it will not be easy to seek treatment at hospitals their trusted doctors may not be affiliated to. They will have to visit hospitals that their doctors recommend or the ones that are located closer to their places of residence.

Also read: Ayushman Bharat scheme's expansion not enough. Quality and choice of care also important

Moreover, given that a large number of people will be visiting these hospitals, elderly citizens will also have to deal with the challenge of having to queue up for tests and treatment. Likewise, they need to be aware that the scheme will ensure basic level of care, but will not provide access to the hospitals’ single private rooms that relatively well-heeled senior citizens tend to prefer.

Senior citizens, who can afford separate health insurance policies, are likely to be better off sticking to their existing covers and treating Ayushman Bharat Vaya Vandana scheme as a back-up instead.