Why senior citizens should combine Ayushman Bharat with private insurance

For expenses exceeding the Rs 5 lakh limit, as well as treatments at other hospitals, the private insurance coverage would be applicable.

As healthcare expenses continue to rise, ensuring adequate medical coverage is critical, especially for senior citizens. With increasing age, the likelihood of health-related issues increases, making health insurance a necessity. Senior citizens can take advantage of both private insurance and the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to create a more comprehensive healthcare safety net. By combining the two, they can enhance their coverage and avoid financial strain during medical emergencies. Here's how they can effectively utilise both.

 

Understanding the Ayushman Bharat Scheme

 

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), a flagship health insurance scheme of the Government of India, has recently expanded its eligibility criteria to include senior citizens above the age of 70 years. 

 

 

The government has clarified that all senior citizens aged 70 and above, who belong to families already covered under AB PM-JAY, will be eligible for an additional top-up cover of Rs 5 lakh per year. This means families can share this coverage between their senior members.

 

“While the annual floater health coverage of Rs 5 lakh per family can help in managing a wide range of secondary and tertiary medical expenses, it may not be sufficient to cover certain high-cost treatments for age-related illnesses,” said Siddharth Singhal, Head - Health Insurance, Policybazaar.

 

Many senior citizens also have their own private health insurance policies, which they have maintained over the years. The good news is that there is no restriction on combining Ayushman Bharat with private health insurance. 

 

This integration means that senior citizens can use their private insurance as their primary coverage and treat Ayushman Bharat as a backup for additional expenses. Essentially, the government-provided coverage complements their private insurance, offering a wider safety net. This approach ensures that they have access to multiple sources of funds when dealing with medical bills, creating a more comprehensive healthcare plan.

 

“Those who can comfortably afford a personal health cover should definitely go for it over and above the Ayushman Bharat coverage. Independent policies typically also offer broader benefits, such as OPD services, wellness programs, and coverage for critical illnesses, which are vital for seniors who require more frequent and specialised healthcare. A personal health cover also ensures continuity of care, especially for those with pre-existing conditions, and guarantees access to quick and seamless care,” Siddharth said.

 

Points to keep in mind when building a comprehensive coverage strategy

 

Assess your needs: Start by evaluating your health condition, family medical history, and potential future requirements. This assessment will help in choosing the right combination of coverage.

 

Understand Ayushman Bharat eligibility: Check if you are eligible for Ayushman Bharat. If you are, it can serve as your base coverage for major hospitalizations.

 

Choose the right private insurance: Look for policies that cover areas not included in Ayushman Bharat. 

 

Consider top-up plans: These plans offer additional coverage over your base policy at a relatively lower premium. They can significantly enhance your overall coverage.

 

Look into critical illness covers: These specialised policies provide a lump sum amount upon diagnosis of specified critical illnesses, helping manage the financial impact of severe health conditions.