Ayushman Bharat completed eight years on 23 September 2026. It was launched on 23 September 2018 at Ranchi, Jharkhand, and the Prime Minister and the Health Minister both marked the anniversary with fresh figures.
Almost every revision note treats Ayushman Bharat as a single health insurance scheme. It is not. It is two schemes bolted together, and they answer two completely different questions. Once you see the split, everything else in the chapter arranges itself.
The Hinge: Two Schemes, Two Different Problems
Ask yourself what actually goes wrong with health in a poor household. Two things, and they are not the same thing at all.
- The everyday problem. There is no doctor, no test and no medicine within reach, so a small illness is ignored until it becomes a large one. This is a problem of distance and availability.
- The catastrophic problem. Someone needs surgery or a long hospital stay, and the bill wipes out the family’s savings, its land or its borrowing capacity. This is a problem of cost.
Ayushman Bharat has one component aimed at each.
| Component | What it is | Which problem it solves |
|---|---|---|
| Ayushman Arogya Mandir | Upgraded sub-centres and primary health centres offering check-ups, maternal and child care, screening for non-communicable diseases, free diagnostics and free essential medicines. Formerly called Health and Wellness Centres | Distance. Care near where you live, for the ordinary things |
| PM-JAY — Pradhan Mantri Jan Arogya Yojana | Cashless secondary and tertiary hospital treatment worth up to ₹5 lakh per family per year | Cost. The bill that would otherwise bankrupt the family |
Two words worth fixing here. Primary care is the first point of contact — a clinic, a check-up, a prescription. Secondary care means a specialist or a district hospital. Tertiary care means advanced treatment at a large hospital — cardiac surgery, cancer, neurosurgery. PM-JAY deliberately does not cover primary care, because the other half of Ayushman Bharat already does.
That is the exam framing to remember: if a question mentions ₹5 lakh, hospitalisation or empanelled hospitals, it means PM-JAY. If it mentions screening, free diagnostics or wellness, it means Ayushman Arogya Mandir. They are both Ayushman Bharat, and they are not interchangeable.
PM-JAY: The Rules That Get Asked
| Feature | Detail |
|---|---|
| Cover | ₹5 lakh per family per year, for secondary and tertiary care hospitalisation |
| Family size, age, gender | No restriction at all. This is unusual and it is asked — there is no cap on how many members a family may have |
| Pre-existing conditions | Covered from day one. There is no waiting period, which is the single biggest difference from a commercial policy |
| Before and after hospitalisation | Up to 3 days before and 15 days after, covering diagnostics and medicines |
| Money paid by the patient | Nothing. It is cashless at the hospital counter, and the beneficiary pays no premium either |
| Portability | Works anywhere in India, at any empanelled public or private hospital, not only in the home State |
Read the portability row twice. A construction worker from Bihar who falls ill in Chennai can be treated on the same card. For a country with very large internal migration, a benefit that does not travel is barely a benefit at all, and this is the feature that distinguishes PM-JAY from the State health schemes it replaced or absorbed.
Who Is Eligible — And the Change That Broke the Pattern
This is the most interesting part of the whole scheme, and most notes skip straight past it.
Originally, you qualified because of what you lacked. Eligibility was drawn from the Socio-Economic and Caste Census of 2011:
- In rural India, a household qualifies if it meets at least one of six deprivation criteria — the categories labelled D1 to D5 and D7. These cover things such as having only one room with kutcha walls and roof, no adult member aged 16 to 59, a female-headed household with no adult male in that age range, a disabled member with no able-bodied adult, and landless households earning mainly from manual casual labour.
- In urban India, eligibility runs through 11 occupational categories — ragpickers, domestic workers, street vendors, construction workers, sanitation workers, home-based workers, transport workers and similar.
Notice what that is not. There is no income certificate and no self-declaration. You do not apply by claiming to be poor; you are on the list because a census recorded a specific deprivation. That design avoids one problem and creates another, which we come to below.
Then, in October 2024, the principle changed. Under Ayushman Vay Vandana, every citizen aged 70 and above became eligible irrespective of income. Someone already covered as a family gets an additional top-up; someone who was never eligible gets a cover of their own.
Why this matters more than it looks. For six years the scheme’s entire logic was deprivation. The 70-plus extension is based on age, and age is not a proxy for poverty. It is the first time the scheme admitted a beneficiary who is not poor, and it is the direction of travel worth naming in any descriptive answer: from a targeted anti-poverty programme towards something closer to universal coverage for the old. Coverage has since been widened again to include the families of ASHA and Anganwadi workers and helpers — about 37 lakh families.
Insurance, or Assurance?
Both words appear in official material and they are not loose talk — they describe two different ways a State can run the same scheme.
| Model | How the money moves |
|---|---|
| Insurance model | The State buys a policy from an insurance company and pays it a premium. The insurer settles the hospital bills |
| Assurance or trust model | The State keeps the money in its own trust fund and pays the hospitals directly. No insurer in the middle |
| Mixed model | A combination of the two |
States choose. What never changes is the part that matters to the patient: the beneficiary pays no premium and no bill under either model. So if a question asks what the beneficiary contributes, the answer is nothing, regardless of which model the State picked.
Who Pays for It
| Where | Centre : State |
|---|---|
| Most States | 60 : 40 |
| North-Eastern States and the three Himalayan States | 90 : 10 |
That 60:40 and 90:10 split is the standard shape of a centrally sponsored scheme, and recognising it saves time across the whole syllabus — the same ratios turn up in scheme after scheme. The Union level is run by the National Health Authority; each State runs its own State Health Agency.
Where It Stands at Eight Years
The figures released around the anniversary, on 23 September 2026:
| Measure | Figure |
|---|---|
| People with access to cover | More than 60 crore |
| Ayushman cards created | About 48.54 crore |
| Hospital admissions funded | About 13 crore |
| Value of treatment authorised | More than ₹2 lakh crore |
| Empanelled hospitals | About 38,000, government and private together |
| Visits to Ayushman Arogya Mandirs | More than 500 crore |
| Geographic coverage | All 36 States and Union Territories |
Two of those rows deserve a second look. First, 60 crore people covered but 48.54 crore cards created — those are different things. Being on the eligibility list is not the same as holding a card, and the gap between the two is the actual measure of how far the scheme has travelled. Second, 500 crore visits to Arogya Mandirs against 13 crore hospital admissions. The half of Ayushman Bharat nobody talks about is being used roughly forty times as often as the half everybody talks about.
The Digital Layer: ABHA
ABHA — Ayushman Bharat Health Account — is a health identity number that lets a person’s records follow them between clinics and hospitals. Do not confuse it with the Ayushman card.
- The Ayushman card is what entitles you to treatment under PM-JAY.
- ABHA is a record-keeping identity and is open to anyone, not only to PM-JAY beneficiaries.
One Honest Limitation
The eligibility list still rests on the Socio-Economic and Caste Census of 2011. That is a survey now fifteen years old. A household that has become poorer since, or a family formed since, does not appear on it, and a household that has climbed out of poverty still does.
This is not a criticism so much as an arithmetic fact, and it points somewhere useful: Census 2027 will be the first fresh national enumeration in sixteen years, and any serious updating of the beneficiary base has to wait for it. Our Census 2027 explainer sets out why a census decides how the country divides everything it has — and a ₹5 lakh entitlement is one of the things being divided.
Where This Sits in India’s Welfare System
A point worth carrying into a descriptive answer, because it puts the scheme in context rather than just describing it.
India runs two parallel social security systems, and which one covers you depends on what kind of job you have.
| System | Who it covers | How it is paid for |
|---|---|---|
| Contributory — EPFO, ESIC | People in formal employment above certain thresholds | You and your employer pay in, every month, as a share of wages |
| Non-contributory — Ayushman Bharat, PM-KISAN | People in informal work, or outside the workforce | The Government pays, out of tax revenue |
So Ayushman Bharat covers you precisely because nothing else does. The formal-sector worker already has ESIC or an employer policy; the wage ceiling that decides who falls inside that system is the subject of our EPFO explainer. The person outside it has no employer to share the cost, so the State becomes the employer for this one purpose. The same logic runs through PM-KISAN, with one difference worth stating: PM-KISAN transfers money, Ayushman Bharat transfers a right to be treated. Cash can be spent on anything; an entitlement cannot.
What Is Likely to Be Asked
- Launched 23 September 2018 at Ranchi, Jharkhand.
- Two components — Ayushman Arogya Mandir for primary care and PM-JAY for secondary and tertiary care.
- ₹5 lakh per family per year, with no cap on family size, age or gender.
- Pre-existing conditions covered from day one; 3 days before and 15 days after hospitalisation.
- Eligibility from SECC 2011 — six rural deprivation criteria, eleven urban occupational categories.
- Everyone aged 70 and above is eligible regardless of income, under Ayushman Vay Vandana.
- Funding 60:40, and 90:10 for the North-East and the Himalayan States.
- Implemented by the National Health Authority at the Centre.
- ABHA is a health record identity, not the Ayushman card.
Five Practice Questions
Q1. Ayushman Bharat PM-JAY was launched on 23 September 2018 at…
(a) Ranchi, Jharkhand (b) Varanasi, Uttar Pradesh (c) Bhubaneswar, Odisha (d) Raipur, Chhattisgarh
Answer: (a) Ranchi, Jharkhand The date is easy to remember because the scheme now marks its anniversary on it every year.
Q2. Which of the following is NOT true of PM-JAY?
(a) There is no cap on family size (b) Pre-existing conditions are covered from day one (c) The beneficiary pays a small annual premium (d) Benefits are portable across India
Answer: (c) The beneficiary pays a small annual premium In fact nothing is paid at all — no premium and no bill. Whether the State runs an insurance or a trust model changes who settles the hospital, not what the patient pays.
Q3. Under Ayushman Vay Vandana, who became eligible in October 2024?
(a) All construction workers (b) All households below the poverty line (c) All citizens aged 60 and above (d) All citizens aged 70 and above, irrespective of income
Answer: (d) All citizens aged 70 and above, irrespective of income Seventy, not sixty, and the words that matter are ‘irrespective of income’ — it is the first time the scheme covered someone who is not poor.
Q4. The Centre and State share the cost of PM-JAY in which ratio for most States?
(a) 50 : 50 (b) 60 : 40 (c) 75 : 25 (d) 90 : 10
Answer: (b) 60 : 40 And 90:10 for the North-Eastern and the three Himalayan States. That pair of ratios is the standard shape of a centrally sponsored scheme.
Q5. The component of Ayushman Bharat that provides primary health care, free diagnostics and screening is called…
(a) PM-JAY (b) Ayushman Vay Vandana (c) Ayushman Arogya Mandir (d) ABHA
Answer: (c) Ayushman Arogya Mandir Formerly called the Health and Wellness Centre. PM-JAY covers hospitalisation only, Vay Vandana is the 70-plus extension, and ABHA is a health record identity.
Ten more questions on this and today’s Static GK capsule are waiting on our Test Your Knowledge page, with a free PDF.
Sources: the Prime Minister’s Office release of 23 September 2026 on the eighth anniversary (PIB Release ID 2313742); the Akashvani News report of the same date carrying the Health Ministry’s figures; the National Health Authority’s official description of PM-JAY for eligibility, cover, portability and cost sharing; and the PIB backgrounder on Ayushman Bharat of 1 November 2025. Figures of this kind move every month, so treat them as the position at the eighth anniversary rather than as permanent.
