Ayushman Bharat PM-JAY: who it covers, and how to actually use it

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, PM-JAY for short, is the government's hospital cover for poorer families, and since late 2024 for everyone aged 70 and over. It pays for admissions at empanelled public and private hospitals, cashless, up to a fixed amount a year. On paper it is simple. In practice, families who are entitled to it still pay hospitals out of pocket, because they do not know they are covered, do not have the card, go to a hospital that is not empanelled for their treatment, or are told at the desk that something is not included.

This piece explains who is eligible, what the cover includes and excludes, how to check eligibility and get the card, how the senior citizen expansion works, and what to do when a hospital asks for money it should not. It describes how the scheme is designed to work, and where it most often does not.

What PM-JAY is

PM-JAY is run nationally by the National Health Authority and, in each participating state, by a State Health Agency. The National Health Authority describes the cover as up to Rs 5 lakh per family per year for secondary and tertiary care hospitalisation, on a family floater basis: the amount is shared across the family, and any one member can use all of it.

Treatment is priced as packages, each covering a defined procedure or condition and the costs that go with it, such as the stay, medicines and tests. According to the National Health Authority, cover extends to up to three days before admission and up to fifteen days after discharge for the same condition. Pre-existing conditions are covered from the first day; there is no waiting period. There is no cap on family size or on the age of members. The cover is portable across the country, so a beneficiary can use it at any empanelled hospital, not only in their home state.

Who is eligible

There are two separate routes into the scheme, and it matters which one applies to you.

The original route is based on deprivation. The scheme was designed to cover the poorest 40 per cent of the population, identified from the Socio-Economic Caste Census of 2011: rural households by its deprivation criteria and urban households by occupational categories. Families covered under the earlier Rashtriya Swasthya Bima Yojana who were not in the census data were also included. A government reply in the Rajya Sabha in February 2026 described the scheme as covering 12 crore families. Several states have since widened eligibility using their own lists or merged PM-JAY with a state scheme, so the rules in your state may be broader than the national definition.

The second route is age. Since the expansion approved by the Union Cabinet on 11 September 2024 and launched on 29 October 2024, every resident aged 70 or over is eligible, regardless of income. This is covered in its own section below.

You do not apply for PM-JAY in the way you apply for a private policy. Under the deprivation route, you are either on the beneficiary list or you are not. What you can do is check, and if you are on it, complete the verification that produces a card.

How to check eligibility and get the card

1. Check whether you are on the listUse the National Health Authority's beneficiary portal, beneficiary.nha.gov.in, or the Ayushman app. You can also ask at an empanelled hospital's PM-JAY desk, or call the national helpline, 14555. Have identity documents and the mobile number you want linked to hand.
2. Complete verificationIf your family is listed, each member completes identity verification, after which an Ayushman card is generated. The card links the person to the family's entitlement. Each member who might need treatment should have one, because the hospital will verify the patient, not the head of household.
3. Download or print the cardOnce generated, the card can be downloaded from the portal or the app. A printed copy is not strictly needed at a hospital, since verification happens against the system, but carrying one, or a screenshot, avoids arguments at the desk.
4. Find an empanelled hospital for your treatmentNot every hospital is empanelled, and an empanelled hospital is not necessarily empanelled for every specialty. The hospital search on the PM-JAY website and in the app shows which specialties each hospital is empanelled for. A government release in November 2024 put the number of empanelled hospitals at over 30,000, a little under half of them private.

If you think you should be eligible but are not on the list, there is no national form to add yourself. Ask at the district office of your State Health Agency whether your state runs a wider scheme with its own enrolment, because that is the most common way families outside the 2011 data are covered.

The 70-plus expansion: Ayushman Vay Vandana

Since October 2024, everyone aged 70 or over can get an Ayushman Vay Vandana card, regardless of income or whether their family was previously eligible. The rules, as set out in government releases at the time, differ depending on what cover the person already has.

Enrolment is through the Ayushman app, the beneficiary portal, or at an empanelled hospital, and the helpline is 14555. A government reply in the Rajya Sabha in February 2026 said more than 96 lakh Vay Vandana cards had been created by 31 December 2025. If an older relative is eligible, get the card before it is needed. Completing verification for a frail person during an emergency admission is exactly the situation the card is meant to avoid.

What happens at the hospital

Every empanelled hospital is meant to have a PM-JAY help desk staffed by a Pradhan Mantri Arogya Mitra, a trained facilitator whose job is to verify beneficiaries, raise the pre-authorisation for the treatment package, and guide the family through admission and discharge. Go to this desk first, before registering as a general paying patient. Once you have been billed as a private patient, converting the admission is harder.

The Arogya Mitra verifies the patient's identity against the system, the treating doctor's diagnosis is matched to a package, and the hospital requests pre-authorisation from the State Health Agency or its insurer. When approved, the treatment proceeds cashless. At discharge, you should receive a discharge summary; ask for it, and keep it. If you later need the records, how to get your medical records explains what to ask for.

Doctors at empanelled hospitals are the same doctors who see private patients there. If you want to know who you will be treated by, you can look up doctors by city and speciality and see which hospitals they are attached to. How to choose a doctor covers what to check beyond that.

If a hospital asks for money

PM-JAY is designed to be cashless at the point of care for treatment within a package. Requests for payment take a few familiar forms: a deposit before admission, a charge for medicines or consumables said to be outside the package, a demand to pay for tests done before admission, or a claim that the package amount has run out. Some of these are legitimate, for instance treatment for a condition the hospital is not empanelled for, or care beyond the remaining balance of the family's annual cover. Many are not.

1. Raise it at the PM-JAY deskThe Arogya Mitra is the first point of contact. Ask them to check whether the item is included in the approved package and, if it is, to stop the demand.
2. Call the helplineThe national helpline, 14555, is listed by the National Health Authority as working round the clock. Note the time of the call and any reference number you are given.
3. File a written grievancePM-JAY has a grievance redressal system run through the State Health Agencies, which can be reached online through the scheme's website and in person at the district level. Attach the receipt, the hospital's written explanation if any, and the patient's card details.
4. Escalate the pattern, not just the caseIf the same hospital repeatedly demands payment from scheme patients, say so in the grievance. Empanelment is a contract, and the State Health Agency can act against a hospital that breaches it.

Where the scheme falls short

The scheme's design is generous; its delivery is uneven. Empanelled hospitals are concentrated in towns and cities, and private empanelment is thin in some districts and for some specialties. Package rates are set by the scheme rather than by the hospital, and some private hospitals regard them as too low for certain procedures, which shows up as reluctance to admit scheme patients rather than as an outright refusal. And many eligible people do not know they are covered, which is the simplest failure and the most expensive for the families concerned.

None of this changes what a beneficiary is entitled to. It changes how prepared you need to be: card in hand before it is needed, the empanelled hospital identified for the likely treatment, and a clear sense of what to say at the desk. In an emergency, a hospital's obligations do not depend on the scheme at all; emergency treatment rights explains what applies. The wider rights you hold in any hospital, scheme or no scheme, are in patient rights in India. For people with private cover as well, cashless and reimbursement claims explains how the insurance side works.

General information about how healthcare in India is organised and regulated, current at 8 Oct 2026. Not advice about your situation, and not for emergencies — call 108. Errors can be reported through the corrections process.