India Explained
ImplementedBJPNarendra Modi

Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PM-JAY)

Hospital insurance scheme launched September 2018, extended in 2024 to all aged 70+; 10.98 crore admissions recorded by December 2025 (administrative count); a 2023 CAG audit raised claim-control issues.

Health insurance

Facts

  • The scheme was launched on 23 September 2018, according to the CAG performance audit (Report No. 11 of 2023, covering September 2018 to March 2021) [1].
  • The CAG audit test-checked 964 hospitals in 161 districts and reported that 2,14,923 claims were shown as paid for 'fresh treatments' to patients recorded as dead, and that about 7.5 lakh beneficiaries were linked to a single mobile number (9999999999), as reported in press coverage of the audit [1][2].
  • The Health Ministry stated that media reports on dead-patient claims were misleading, that pre-authorisation can be started up to three days before admission, and the National Health Authority later filed an Action Taken Note [2].
  • In October 2024 the scheme was expanded to provide cover of Rs 5 lakh per year to all citizens aged 70 and above irrespective of socio-economic status [3].
  • As of 31 December 2025 the Economic Survey 2025-26 reports 42.78 crore Ayushman Bharat cards generated, 10.98 crore hospital admissions, 49% of beneficiaries female and 6 crore senior citizens covered [4].
  • NFHS-5 (2019-21) found that 41.0% of households had at least one member covered by a health insurance or financing scheme (all schemes, not only PM-JAY) [5].

Why

Reasons given by those who did it

  • The Economic Survey 2025-26 describes Ayushman Bharat as addressing health 'at primary, secondary and tertiary levels by adopting a continuum of care approach' and credits it, with the National Health Mission, with improvements in access [4].
  • The Government stated in Parliament that the October 2024 expansion extends free cover to senior citizens aged 70 and above irrespective of their socio-economic status [3].

Criticism of that reasoning

  • The CAG audit questioned beneficiary identification and claims controls, including claims for patients recorded as dead and mass linking of beneficiaries to one phone number; the Ministry disputed how some findings were characterised [1][2].

Benefits and concerns

Benefits (2)

  • Large volume of insured hospital treatment recorded.10.98 crore hospital admissions and 42.78 crore Ayushman Bharat cards as of 31 December 2025 (Economic Survey 2025-26, citing programme data) [4]. These are administrative counts; they do not show whether admissions were additional or reduced out-of-pocket spending.
  • Extension of cover to senior citizens regardless of income.From October 2024, Rs 5 lakh per year to all aged 70 and above; the Economic Survey reports 6 crore senior citizens covered [3][4].

Concerns (2)

  • Audit findings on data quality and claim controls.CAG Report No. 11 of 2023: 2,14,923 claims for patients recorded as dead and about 7.5 lakh beneficiaries tied to one mobile number, in a test check of 964 hospitals [1][2]. The Ministry's reply: pre-authorisation up to three days before admission can explain some cases [2].
  • Insurance coverage across households remained partial at the last national survey.NFHS-5 (2019-21): 41.0% of households had a member covered by any health insurance or financing scheme, implying about 59% had none [5]. The survey predates the 2024 expansion.

Evidence points

+8.0
points, mean of two scorers (scale −25 to +25)
+7 to +9
range between the two scorers' totals
Low confidence
scorers agree within 1 point on every criterion
ReachHow many people did the action materially affect?
Mean +4.5A +4B +5
Outcome evidenceDo official or independent data show the intended result (or its opposite), compared with the era baseline and peers?
Mean +1.0A +1B +1
Cost and sustainabilityIs the fiscal cost proportionate, and is the effect durable?
Mean +0.5A +1B 0
Process and rightsWas it made with debate, consultation and legal soundness, and did it respect rights and court rulings?
Mean +0.5A +1B 0
DeliveryWas it implemented as announced, on time and at scale?
Mean +1.5A +2B +1

Positive meanNegative meanScorer AScorer B

Scorer A. Large administrative counts of cards and admissions, but audit findings on claims controls and no evidence of reduced out-of-pocket spending keep outcome modest.

Scorer B. Large admission counts but CAG found data and claim control failures and survey coverage remained partial, so outcome evidence is limited.

Context used when scoring

Era baseline
In 2019-21 (NFHS-5) a minority of households (41.0%) had any member covered by a health insurance or financing scheme.
Lag before outcomes show
4 years
Shocks considered
covid-2020
Uncertainty
Low confidence. Scorer totals are +9 and +7. How uncertainty is shown.

In depth

PM-JAY provides publicly funded cover for hospital treatment to eligible families and is administered by the National Health Authority. In October 2024 it was extended to all citizens aged 70 and above, with cover of Rs 5 lakh per year.

Administrative data show a large and growing number of authorised admissions. These data measure use, not health outcomes or reductions in household spending, and the sources reviewed here do not contain a national impact evaluation. The CAG’s 2023 audit examined the first period of the scheme and raised issues about the beneficiary database and claims controls; the Ministry said some of the media characterisations were misleading and responded to the audit recommendations.

NFHS-5 shows that about two in five households had some member covered by a health insurance or financing scheme in 2019-21. This includes state and employer schemes, not only PM-JAY, and the survey was conducted before the 2024 expansion, so it should not be read as a measure of PM-JAY alone.

Assessments of the scheme therefore rest on three kinds of evidence: scale of use, audit findings on controls, and coverage gaps. Longer-run evidence on financial protection and health outcomes is limited in the sources reviewed.

Sources

  5. National Family Health Survey (NFHS-5), India, 2019-21
    International Institute for Population Sciences / Ministry of Health and Family WelfareOfficial data

Last reviewed .Report an error orchallenge a score.

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