Ayushman Bharat extension: Welcoming 70+ Seniors

Dipak Kurmi

(The writer can be reached at dipakkurmiglpltd@gmail.com.)

The inclusion of senior citizens aged 70 and above in the BJP manifesto for the ongoing 2024 Lok Sabha elections, under the government’s flagship healthcare programme, is indeed a commendable step. It directly addresses a pressing concern of the elderly population, who often struggle to secure adequate health coverage. However, while the initiative is a positive move, there remains room for improvement in its scope and coverage. Initially launched on the eve of the 2019 general elections, the programme aimed to provide health cover to approximately 50 crore individuals or 10 crore families, offering free hospital treatment up to Rs 5 lakh per annum. Despite its noble intentions, there has been some subtle criticism regarding the breadth of its coverage. For instance, the inclusion of various professions, such as tailors, has drawn scrutiny. Critics argue that such occupations may encompass individuals who are financially stable, overlooking the targeted subsidy nature of Ayushman Bharat.

The glaring absence of senior citizens from the healthcare coverage scheme has sparked considerable frustration, particularly in a nation where they often face discrimination from health insurers. Senior citizens are frequently labelled as high-risk individuals, resulting in exorbitant premiums or outright denial of coverage. Consequently, even those who are financially stable find themselves compelled to resort to self-insurance. This entails forgoing traditional health insurance and instead establishing a reserve fund to cover medical emergencies and essential geriatric treatments such as dental implants, joint replacements, and cataract surgery. These routine procedures, crucial for maintaining quality of life in old age, are often neglected or unfairly penalized by insurance providers.

The BJP’s acknowledgment of senior citizens’ concerns, albeit delayed and somewhat begrudgingly, is a step in the right direction. However, the imposition of a 70-year age requirement raises questions. The title of’senior’ typically accompanies retirement at 60, yet eligibility for Ayushman Bharat is set much later. While life expectancy in India has risen steadily, hovering around 67 years according to the 2021 census, ensuring a longer and healthier life cannot be left to chance. Geriatric ailments often manifest well before the age of 70, underscoring the need for earlier intervention. It’s hoped that the government will adopt a more inclusive approach, extending Ayushman coverage to individuals aged 65 and above. While the BJP manifesto marks progress, it’s reassuring that there’s no promise of coverage for’very senior citizens,’ defined as those over 80 years per income tax law. Nonetheless, this is a positive step forward.

One can only hope that the new initiative will be wholehearted and not overlook common geriatric issues like dental and vision problems. Additionally, many seniors grapple with conditions like high blood pressure and diabetes, necessitating daily medication to manage these potentially life-threatening ailments, often dismissed as “lifestyle diseases.” Indian health insurance typically focuses on hospitalization, but there’s no reason why coverage for senior citizens shouldn’t extend to cover pharmacy bills, especially if supported and certified by government doctors on an annual basis. The government’s apparent preference for hospital bills over pharmacy bills, citing concerns about fraudulent claims, may seem reasonable at first glance. However, it’s essential to ensure that seniors receive comprehensive support for their healthcare needs, including access to medication and preventive treatments.

Despite the heightened deduction under Section 80D of the Income Tax Act, aimed at providing some relief for senior citizens and their families bearing their health insurance premiums, it’s evident that this measure merely scratches the surface of the issue. The extension of Ayushman Bharat coverage to senior citizens marks a significant and much-needed step forward, representing the first meaningful initiative by any political party to address their healthcare needs. However, there are lingering concerns about the effectiveness of this newfound coverage. The loopholes surrounding pre-existing conditions and the long list of exclusions threaten to dilute the impact of this initiative. Conditions like osteoporosis and dental issues, which are common in old age, should not be overlooked in the coverage. The ability of insurers to exploit the pre-existing disease clause is particularly frustrating for policyholders, highlighting the need for greater transparency and accountability in the insurance sector. One can only hope that if the BJP is re-elected, they will follow through on their promises and ensure that this new health cover truly benefits senior citizens without unnecessary barriers or exclusions.

While Rs 5 lakh cover per annum is certainly significant, it shouldn’t be rigidly enforced. Consider a scenario where hospital bills amount to Rs 6 lakh; it would be impractical for individuals to bear the excess cost, potentially forcing them to dip into their savings. A more flexible approach would involve adjusting the excess amount over Rs 5 lakh from the following year’s quota, ensuring that individuals aren’t burdened with unforeseen medical expenses. Additionally, there may be instances of fortuitous circumstances, such as hospitalization spanning two financial years, which could inadvertently result in higher coverage. For example, if one is admitted on March 15 and discharged on April 15, they would be eligible for a cover of Rs 10 lakh, spanning two years. Adopting such flexible measures would provide greater financial security and peace of mind, especially during the later stages of life.

As it stands, the scheme is designed to cover entire families, meaning that the Rs 5 lakh coverage extends to a household, regardless of its size. However, this approach can inadvertently disadvantage larger families, particularly those facing financial hardship. There’s a lingering question about whether the same family unit concept will apply to senior citizen couples. For instance, if a husband is 75 years old and his wife is 72, will they both be restricted to a combined cover of Rs 5 lakh per annum, or will each receive a separate cover of Rs 5 lakh annually? The intricacies of such details can significantly impact the effectiveness and fairness of the scheme, underscoring the importance of clear and comprehensive guidelines to ensure equitable access to healthcare for all.