Ayushman Bharat: who it covers
Source: National Health Authority · Last updated July 2026
Families covered
12+ crore
Cover per family
₹5 L/year
Ayushman Bharat PM-JAY is the world’s largest publicly funded health insurance scheme. It provides hospitalisation cover of ₹5 lakh per family per year to over 12 crore families — roughly the bottom 40% of India’s population.
Who is eligible
- Families identified by the SECC 2011 deprivation criteria (rural and urban occupational categories)
- All households with a member aged 70 or above, regardless of income (from 2024)
- State-specific additions — many states have expanded coverage
What is covered
- Hospitalisation: Secondary and tertiary care at empanelled public and private hospitals
- Pre-existing conditions: Covered from day one — no waiting period
- Procedures: Covers 1,900+ medical procedures
- Cashless: Beneficiary pays nothing at the point of care
💡 Key insight: PM-JAY covers only hospitalisation. It does not cover outpatient visits, medicines bought at pharmacies, or diagnostic tests done outside a hospital. Most out-of-pocket health spending in India is on these — which is why the scheme has a limited effect on household health costs.
Why it matters
- Health shocks: Hospitalisation is one of the biggest causes of debt for poor households in India
- Reduces catastrophic spending: Studies show PM-JAY reduced catastrophic health expenditure for enrolled families
- Evidence gap: Independent evaluations find mixed results on health outcomes, with awareness and usage still low in some states
Source
National Health Authority (NHA), PM-JAY dashboard; Ministry of Health and Family Welfare. Figures reflect the most recent data available as of July 2026.