Over the last decade, health insurance coverage among the population above 70 in India has expanded from around 15 percent in 2017-18 to over 55 percent by September 2025.
As the world marks the United Nations International Day of Older Persons on 1 October 2025, with the theme ‘Older Persons Driving Local and Global Action: Our Aspirations, Our Well-Being and Our Rights,’ India’s push to universalise the Pradhan Mantri Jan Arogya Yojana (PMJAY) for those aged seventy and above reads as a concrete affirmation of these aspirations and rights. It places older citizens at the centre of health policy rather than at its margins. When universal coverage for citizens aged seventy and above titled Ayushman Vay Vandana (AVV) was announced, three out of the 36 states and union territories were not part of PMJAY. Since then, two — Odisha and Delhi — have joined, with only West Bengal remaining outside. The initiative is therefore on the cusp of becoming truly national.
When universal coverage for citizens aged seventy and above titled Ayushman Vay Vandana (AVV) was announced, three out of the 36 states and union territories were not part of PMJAY. Since then, two — Odisha and Delhi — have joined, with only West Bengal remaining outside.
India decided on 11 September 2024 to extend PMJAY to everyone aged seventy and above. Income was no longer an eligibility criterion, thus reframing health protection in later life. The notification created two clear pathways. Seniors already inside a PMJAY family would receive a shared top-up of INR 5 lakh. Seniors currently outside PMJAY receive coverage of INR 5 lakh on a family basis. The intent is simple: India seeks to remove income filters at an age when needs arise and budgets strain.
The expansion runs through a distinct Ayushman Vay Vandana card. The National Health Authority (NHA) states that every eligible senior receives a separate card. Applications can be filed on the portal or through the app, and also with support from health workers at facilities. Notably, treatment can start the day enrolment is approved. In the context of the historic universalisation of hospitalisation cover for those aged 70 and above, this article attempts to track the expansion of coverage over the last year.
Two firm signals have appeared over the last year. In a reply to the Rajya Sabha on 29 July 2025, the Ministry of Health reported that more than 1.06 lakh claims were settled under AVV. This indicates that enrolment is turning into admissions and procedures for older patients. The reply also emphasised national portability for those enrolled. A second signal concerns the provider base. Latest government updates note 33,080 empanelled hospitals under PMJAY across India. Of these, 15,397 are private facilities. This network makes portability practical when seniors and caregivers are informed and supported on how to access it.
The analysis shows that from a very low coverage of around 7.3 million out of a total of 49 million persons above age seventy in 2017-18, the coverage had expanded to 25 million out of a total of 65 million population above seventy by September 2024, largely thanks to PMJAY, which was launched in 2018.
The latest official population figures for India are for 2011, and official projections indicate that there are 6.7 crore Indians over the age of seventy in 2025. Against this population, which needs to be covered by AVV within PMJAY, a back-of-the-envelope calculation of the health coverage expansion for the 70+ population over the last year is attempted using publicly available government data. Graph 1 explores the pre-PMJAY health insurance coverage of the 70+ population, and both pre- and post-AVV coverage as well. The analysis shows that from a very low coverage of around 7.3 million out of a total of 49 million persons above age seventy in 2017-18, the coverage had expanded to 25 million out of a total of 65 million population above seventy by September 2024, largely thanks to PMJAY, which was launched in 2018. After AVV was launched in September 2024, the coverage has further expanded to 37 million, out of the current projected population above seventy, which is 67 million. This means that over 55 percent of India’s population above seventy is covered by health insurance.
Source: Calculation based on data from Population Projections, LASI Report, PMJAY Dashboard
This effort requires a range of assumptions, as the latest available numbers from the definitive survey examining health insurance coverage of the senior population, the Longitudinal Ageing Study in India (LASI), are for the year 2017-18, which is used as a baseline. Age-disaggregated coverage information for PMJAY is no longer available on NHA’s PMJAY dashboard (which was available earlier), and it is assumed that PMJAY proportional coverage for the population above sixty and the population above seventy are the same. Lastly, private insurance and other employment-linked health insurance coverage are kept constant at 5 percent of the total above seventy population, in line with LASI findings. According to data available from September 2024 from NHA, 33 percent of the above sixty age-group population was covered by PMJAY, and at a proportional coverage, it meant that 42 percent of the total enrolment above sixty was within the above seventy age-group.
It is important to note that Delhi and Odisha coming into the PMJAY fold in 2025 would have inflated the AVV coverage presented for September 2025. Similarly, some of the pre-AVV coverage of the above seventy population within PMJAY would have already shifted to the AVV coverage, thus causing some double-counting in the estimate for September 2025. However, a look at states like Nagaland and Meghalaya, which already had near-population-level coverage pre-AVV, suggests that this has not started on a large scale. Nagaland has, over the last year, only approved 103 AVV enrolments and Meghalaya, 204, showing that the above seventy population already part of the PMJAY coverage has not been migrated to the new scheme yet. The proportion of coverage for the above seventy population within the senior population is bound to go up as the AVV matures across states, but the effort to cover the remaining 45 percent can be challenging, given the awareness gaps that earlier surveys have mapped. The true extent of health insurance coverage and awareness among the senior population will be clear when the wave 2 LASI (2025) results are published.
A committee was constituted, and stakeholder engagements helped shape standards, roles, and convergence across health, social care, and digital tools.
NITI Aayog’s position paper on senior care reforms in 2024 helps explain what must surround insurance for it to serve seniors well. It observes that India has emphasised facility-based medical care, while home-based and non-medical care have received limited attention. It also highlights the absence of national standards for senior-care services and the need for regulatory and monitoring frameworks that ensure quality and affordability across providers. Insurance cannot, on its own, deliver effective protection without these elements. To complement the insurance coverage, the report set out a wider agenda that aligns with PMJAY’s — now AVV’s — push. It calls for person-centred primary care that responds to the needs of older people, and for access to long-term care where required. It also underlines workforce needs in geriatric care skills and the importance of a knowledge base on disease patterns in later life. These points matter because many claims for seniors relate to chronic conditions and multi-morbidity, which demand consistent follow-up and reliable pathways from home to facility and back.
India has begun to organise this space. In 2024, a senior-care reform process was launched at the national level, led by the NITI Aayog. A committee was constituted, and stakeholder engagements helped shape standards, roles, and convergence across health, social care, and digital tools. Such steps can support AVV by giving providers and payers a common frame for quality and continuity.
As AVV coverage expands fast, the immediate priority is to translate approvals into care. The delivery of AVV cards seems to be lagging behind approvals — just about 12,500 deliveries against 8 million approvals — as per the AVV dashboard, although delivery is not a necessary condition for care. Approval confers eligibility, so hospitals and help-desks should support same-visit e-card download or print and provide benefit counselling before discharge from the desk. Outreach should then focus on those who face the steepest barriers. ASHAs, Anganwadi Workers, and Village Level Entrepreneurs (VLE) through the Common Service Centres (CSC) can guide seniors through the process in communities where awareness and mobility are low. Rural areas merit special attention. Widowed women and people aged eighty and above often confront multiple disadvantages and need tailored support. Restoring age-wise disaggregated data access on the PMJAY and AVV portals would help ensure that researchers have access to real-time progress, and this should facilitate course-correction, where needed.
Rural areas merit special attention. Widowed women and people aged eighty and above often confront multiple disadvantages and need tailored support.
One year in, the Ayushman Vay Vandana has moved from announcement to use, with coverage now spanning almost the entire country. The network is large, coverage is portable, and claims are rising. The next step is to expand into hard-to-reach populations, speed up approvals, and convert them into first treatments, while building the senior-care ecosystem around them. Standards, workforce training, home-based care, and thoughtful technology will help achieve this goal. That is how India can turn a bold entitlement into reliable protection for every person aged seventy and above who needs care.
Oommen C. Kurian is Senior Fellow and Head of the Health Initiative at the Inclusive Growth and SDGs Programme, Observer Research Foundation.
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Oommen C. Kurian is Senior Fellow and Head of the Health Initiative at the Inclusive Growth and SDGs Programme, Observer Research Foundation. Trained in economics and ...
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