Ayushman Bharat Scheme Vs Private Insurance: Know Their Key Differences

The PM Ayushman Bharat Jan Arogya Yojana scheme was launched on September 11, 2024, to provide annual health insurance coverage of up to Rs 5 lakh to senior citizens. However, the government has recently modified the plan to give an additional Rs 5 lakh exclusively for citizens aged 70 and above, regardless of their economic status. The scheme is available for treatments in all secondary and tertiary hospitals. Senior citizens already enrolled in the plan will receive an additional Rs 5 lakh, bringing the total per family to Rs 10 lakh if they are 70 and above. The scheme has over 29,000 empanelled hospitals with pre- and post-insurance coverage. 
 

Here are some key difference between private insurance and Ayushman Bharat scheme. 

Coverage and Benefits   

 
PM-JAY: Covers secondary and tertiary healthcare services for economically challenged households. It covers treatments for specific health issues outlined in the programme.  
 
Private Insurance: Coverage varies depending on the plan. Private coverage may provide more benefits, such as outpatient care, wellness, and a wider selection of therapies.  

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Eligibility  

 
PM-JAY: The scheme targets low-income households. People from the economically weaker section are eligible, except senior citizens who are eligible regardless of their income status.  
 
Private Insurance: Available to everyone who can afford. Insurers provide different schemes targeting different age demographics.  
 

Cost 

 PM-JAY: It is free for all eligible beneficiaries as it is government-funded. 
 
Private Insurance: Premiums must be paid on a monthly or annual basis, and deductibles and co-payments may incur out-of-pocket costs. 
 
Network of Providers 

PM-JAY: The program covers only selected hospitals and healthcare providers. 
 
Private Insurance: Often includes a large network of hospitals and may let one pick physicians outside the network. However, it may cost more. 
 
Claim Process 

PM-JAY: Claims are resolved directly between the hospital and the government. 
 
Private Insurance: Settled between the insurer and the patient, but may involve more paperwork or a certain percentage of the bill, depending on the plan. 
 

Rules and Oversight 

PM-JAY: Government rules apply to all aspects of the policy to ensure proper standards and services. 
 
Private Insurance: Government regulations apply, but policy specific exclusions and claims processes may vary. 

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Renewability and Portability 

PM-JAY: The coverage gets renewed automatically for the promised sum, regardless of any claim, as long as the eligibility conditions are met. 
 
Private Insurance: Policies must be renewed periodically, and the terms might vary, impacting the cost.