The Government of India has recently announced a major extension of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) scheme to include all senior citizens aged 70 years and above, irrespective of their socio-economic status. This extension, issued through a notification by the National Health Authority on September 29, 2024, brings significant implications for senior citizens, including Central Government pensioners already covered under the Central Government Health Scheme (CGHS). The question arises—will this new scheme prove beneficial to those who are already receiving CGHS benefits?
Key Features of AB PM-JAY for Senior Citizens
Under the extended AB PM-JAY scheme, all senior citizens aged 70 and above, regardless of their financial background, are entitled to health coverage. The scheme offers:
- ₹5 lakhs health coverage per family per year, applicable to all senior citizens in the family.
- An additional top-up of ₹5 lakhs per year exclusively for senior citizens aged 70 and above.
This coverage aims to provide financial protection for elderly citizens needing medical treatment. Enrollment for the scheme is based on Aadhaar-linked eKYC, and the age registered in the Aadhaar database will determine eligibility. The only required document for registration is the Aadhaar card, and the process will be open throughout the year with no enrollment cutoff date.
Choice Between CGHS and AB PM-JAY
One of the most significant aspects of the new extension is the option given to Central and State Government employees to choose between their current health scheme and AB PM-JAY. For Central Government employees and pensioners, the CGHS is a well-established healthcare system offering access to a range of services, including private hospital treatments and dedicated CGHS wellness centers.
Under this new policy, government employees and pensioners can select either to continue with CGHS or opt for the AB PM-JAY scheme. This option is aimed at avoiding overlap or duplication of benefits between multiple health schemes.
The Benefits Comparison: CGHS vs. AB PM-JAY
For pensioners covered under CGHS, the question arises: should they remain with CGHS or switch to the AB PM-JAY scheme? Here are some key differences:
- CGHS Facilities:
- CGHS provides extensive healthcare services, including access to private hospitals and exclusive CGHS wellness centers.
- Pensioners pay a one-time contribution to access CGHS facilities.
- CGHS offers comprehensive outpatient services, along with treatment for chronic diseases and specialized care.
- AB PM-JAY Scheme:
- AB PM-JAY offers cashless treatment for up to ₹5 lakhs per year for senior citizens and an additional top-up of ₹5 lakhs for those aged 70 and above.
- Unlike CGHS, AB PM-JAY focuses on insurance-based coverage, meaning it may not provide dedicated wellness centers or outpatient services.
- The scheme is entirely free for eligible senior citizens, with no requirement for prior payment or contribution, as seen with CGHS.
Evaluating the Best Option for Pensioners
From the initial assessment, it seems that while AB PM-JAY provides valuable financial coverage, it may lack the comprehensive healthcare services that CGHS offers, especially in terms of outpatient care and access to wellness centers. For pensioners accustomed to the facilities and services provided under CGHS, switching to AB PM-JAY might mean losing certain benefits, such as specialized healthcare and dedicated centers for treatment.
At this juncture, it appears that continuing under CGHS may be the better option for Central Government pensioners, especially those who require frequent medical attention and access to CGHS wellness centers. The convenience of CGHS facilities and the range of treatments available, particularly in private hospitals, might outweigh the additional ₹5 lakhs top-up offered by AB PM-JAY.
Can Both Schemes Coexist?
There is also a growing opinion that Central Government employees and pensioners should be allowed to avail benefits from both schemes simultaneously. This could provide a dual advantage—those enrolled under CGHS could continue accessing its wellness centers while also benefiting from the financial protection offered by AB PM-JAY for larger medical expenses. Such a move would minimize the financial burden on pensioners while allowing them to access the best healthcare options available under both schemes.
In conclusion, while the extension of AB PM-JAY is a significant welfare measure for senior citizens aged 70 and above, pensioners already covered under CGHS may find it more beneficial to stay with CGHS. However, the possibility of combining both schemes could offer an even better solution for the healthcare needs of senior citizens in India.