Ayushman Bharat PMJAY 2025: Who Is Eligible for the Extra ₹5 Lakh Top-Up Cover? Complete Details Explained

Rising healthcare costs have become a major concern for Indian families. From diagnostic tests to surgeries and long-term treatment, medical expenses are increasing every year. For households with limited income, a single serious illness can wipe out lifetime savings. To address this challenge, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) has emerged as a strong safety net for millions of poor and vulnerable families across India.

In 2025, the government has further strengthened this flagship health insurance scheme by introducing an additional ₹5 lakh top-up cover for a specific group of beneficiaries. This means eligible families can now get health coverage of up to ₹10 lakh per year. Here is a detailed, easy-to-understand explanation of who qualifies for this extra benefit and how the scheme works.

What Is Ayushman Bharat PMJAY?

Ayushman Bharat PMJAY is the world’s largest government-funded health insurance scheme. Under this program, eligible families receive cashless health coverage of up to ₹5 lakh per year for secondary and tertiary care treatment.

The scheme covers treatment in both government and empanelled private hospitals across India. One of its biggest advantages is that it also includes pre-existing diseases, meaning patients do not have to wait for years to get coverage for chronic illnesses such as diabetes, heart disease, or kidney problems.

Key Features of Ayushman Bharat PMJAY

• Annual health cover of ₹5 lakh per family

• Cashless treatment across India

• Coverage for pre-existing medical conditions

• No limit on family size

• No age restriction for general beneficiaries

• Includes hospitalisation, surgery, medicines, diagnostics, and follow-up care

One Ayushman Card, Coverage for the Entire Family

Ayushman Bharat is not limited to just parents and children. A single Ayushman Card can be used to provide treatment for the entire family, including:

• Husband and wife

• Children

• Parents and grandparents

• In-laws

• Brothers, sisters, and other dependent family members living together

There is no need to apply separately for each family member. One card ensures cashless treatment for all eligible members under the same household.

Who Gets the Extra ₹5 Lakh Top-Up Cover?

In a major update introduced last year and continuing in 2025, the government announced an additional ₹5 lakh top-up cover for senior citizens aged 70 years and above.

This means:

• Families with at least one member aged 70 years or older can get total health coverage of up to ₹10 lakh

• The extra cover is especially helpful for treating critical illnesses such as cancer, heart surgery, kidney transplants, and other high-cost medical procedures

This enhancement is aimed at protecting elderly citizens, who are more vulnerable to serious health conditions and rising treatment costs.

Eligibility Criteria for the Extra ₹5 Lakh Top-Up

The eligibility process for this additional benefit has been kept simple to ensure maximum reach.

• The beneficiary must be 70 years or older

• Age verification is done using the date of birth mentioned on the Aadhaar card

• No income proof is required

• No additional poverty certificate or document is needed

• No fresh registration is mandatory if already covered under PMJAY

Once eligibility is confirmed, the extra top-up is automatically linked to the existing Ayushman coverage.

Why This Extra Coverage Is Important

Medical treatment for senior citizens often involves long hospital stays, expensive surgeries, and ongoing care. The additional ₹5 lakh top-up acts as a financial shield, ensuring families do not fall into debt or sell assets during medical emergencies.

For households with elderly parents or grandparents, this enhanced coverage can be life-changing, offering both financial relief and peace of mind.

Final Takeaway

Ayushman Bharat PMJAY 2025 continues to evolve as a powerful healthcare support system for India’s most vulnerable citizens. With the introduction of the extra ₹5 lakh top-up for senior citizens aged 70 and above, the scheme now offers stronger protection against high medical costs.

In simple terms, if your family includes a senior citizen aged 70+, you may now be eligible for up to ₹10 lakh of annual cashless health coverage—without complicated paperwork or income verification. This move reinforces the government’s commitment to affordable and accessible healthcare for all.