Sanil Basutkar
Author
A popular news article reported that in 2025, healthcare costs in India are expected to rise by 13% which is higher than the global average of 10%. The reason for the drastic rise in healthcare costs poses a significant challenge for most Indians, as 31% of the country still resides in the middle-income section. This makes affording healthcare increasingly difficult for most senior citizens, as they live on pensions and do not have a regular source of income compared to younger generations.
Government health insurance for senior citizens offers an affordable option, lowers all out-of-pocket expenses, and also offers financial security. In this blog, we will discuss how government-sponsored health insurance can be helpful for senior citizens, and note down the specific schemes.
The Insurance Regulatory and Development Authority of India (IRDAI) has published strict regulations regarding health insurance for senior citizens. This was done to ensure much better access to insurance for the elderly, and also defend them from healthcare cost inflation.
Here are the main guidelines stated in the circular published on January 1, 2025, by IRDAI:
The objectives behind these regulations of IRDAI were:
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Here are the most relevant senior citizen health insurance schemes by the Indian government, many of which offer completely free or subsidized insurance coverage. For simplification, we have classified the schemes into two segments, the General Insurance Schemes and the State-Level Insurance Schemes.
PM-JAY is India’s largest government-aided health insurance scheme, offering up to ₹5 lakhs of cashless hospitalization benefits to families from the secondary and tertiary sector. To note, the secondary industry usually refers to the manufacturing and construction sector. On the other hand, the tertiary sector refers to the service-based industry such as healthcare and education. Currently, the scheme has helped almost 55 crore individuals across India and is expected to help more.
The scheme covers over 1,500 medical packages, which include specialized medical treatments and implants such as joint replacement, dialysis, and even cancer treatments.
This is a Central Government health insurance scheme, designed to insure Central Government employees as well as pensioners. The scheme has already benefited 42 lakh beneficiaries pan India and is expected to cover more citizens shortly. Beneficiaries under this scheme get access to specialist consultations, OPD treatments, and artificial implant cost coverage.
A report published by the Ministry of Transport and Highways reported that in 2022, more than 4 lakh people have passed away from road accidents in India. The numbers are increasing, and because of this, the government has launched the PMSBY Scheme which protects elders from road accidents.
This scheme is another flagship scheme initiated by the Indian government to provide insurable employment to most people covered under this. Although this scheme is not targeted to cover the senior citizens particularly, it does insure the elderly population also. For people with disability, the scheme offers a medical benefit plan where one has to pay ₹10 per month. Let’s explore more of these in detail.
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The Life Insurance Corporation of India (LIC) launched this scheme for all senior citizens. The scheme acts as a pension scheme for retired personnel and offers a dedicated benefit to elderly people in times of need. The scheme runs directly for 10 years, and the pension is paid out to the elderly on either a quarterly or half-yearly basis. In addition to that, the policy assures a guaranteed return of 9.5% per annum. Here are the minimum and maximum pensions available for this scheme:
| Type of pension | Monthly | Quarterly | Half-yearly | Yearly |
|---|---|---|---|---|
| Minimum pension | ₹1,000 | ₹3,000 | ₹6,000 | ₹12,000 |
| Maximum pension | ₹9,250 | ₹27,750 | ₹55,500 | ₹1,11,000 |
Yashawini Health Protection Scheme is not senior citizen-centric insurance, but it is more focused on cooperative societies and inclusive families. The government of Karnataka launched this scheme to cover the majority of the families inhabiting Karnataka at minimal premium.
In Kerala, the most popular government health insurance for senior citizens is the Karunya Arogya Suraksha Padahathi Scheme. This scheme provides an assured coverage of ₹5 lakhs per family on a family floater basis, covering around 42 lakh Keralite families. Currently, the scheme covers almost 40% of the population in Kerala, making the policy one of the widely adopted health insurance schemes in Kerala.
The scheme offers an insurance coverage of ₹1.5 lakh per family, covering a total of 996 types of medical treatments in Maharashtra. A large number of hospitals have been empanelled under this specific scheme, as 2.72 crore families have registered under this scheme. Both secondary and tertiary illnesses are covered in this scheme.
This is a state-level scheme that offers a total coverage of ₹5 lakhs to every family residing in West Bengal, with all pre-existing diseases covered. The insurance cost is entirely borne by the state government, and currently, beneficiaries can avail of the services from a mobile-based app too.
This scheme is specific to the state of Gujarat, launched by the state government in 2012 to support its people who are living Below the Poverty Line (BPL). The main reason to launch this scheme was to enable the state-based people to avail medical as well as surgical benefits across all the empanelled health care units.
For people inhabiting Rajasthan, this scheme is a government-aided health insurance that aims to protect the people there against serious illness. It is a cashless central government health insurance scheme and has so far helped almost lakhs of Rajasthan households.
Also, read the main differences between OPD and IPD treatments.
Government health insurance schemes in India and individual health insurance schemes differ in terms of coverage, cost, and renewal dates. This table below clearly distinguishes them both:
| Basis of difference | Government Health Insurance | Individual Health Insurance |
|---|---|---|
| Cost borne by beneficiary | Subsidized by the government and mostly free | Beneficiary has to bear entire cost |
| Coverage extent | Covers most pre-existing diseases and basic treatment | Covers maximum known diseases and medical treatments |
| Eligibility for enrollment | Accessible by all, also based on state and social category | Accessible to only those who purchase the policy and have covered the premium |
| Flexibility | Limited only to government empanelled hospitals | Open to hospitals that are empanelled by the insurer |
| Claims process | Much slower has multiple stages of paperwork | Faster process to claim benefits |
| Waiting period | Has longer waiting periods | Has shorter waiting periods but also depends on individual policy type |
| Personalization degree | Cannot be personalized and comes with pre-defined benefits | Can be customized according to beneficiary needs |
The eligibility criteria for senior citizen health insurance scheme by government of India usually differs, but in general it includes:
Some schemes may require the beneficiary to have a specific occupational category such as domicile workers or cooperative fisherman
Most of these schemes do cover pre-existing disease conditions (PED), although not all of them. You can check out these government health insurance schemes in India that cover PED conditions:
However, many of these government health insurance schemes have certain eligibility criteria to fulfill before applying for a health insurance scheme, which needs to be noted. In India, a large portion of senior citizens still do not carry any health insurance. Popular news media reports that by 2031, the elderly population in India will increase by 560 lakh more with extremely low insurance awareness. Senior citizens are the most vulnerable population to critical illness, and without insurance coverage, they can face lethal situations.
Choosing a government plan or a private plan is still a challenge. You have to consider factors such as coverage benefits, limitations, and claim process in each of these plans.
We made a table below to help you to choose the right plan more easily.
| Basis of Difference | Government Health Insurance | Private Health Insurance |
|---|---|---|
| Premium paid | Premium is much low and most times it is zero | Premium paid is dependent on the plan considered |
| Coverage for Pre-Existing Disease | Most of the government schemes cover PED, while few may not | Private insurance schemes usually cover PED |
| Critical Illness Coverage | Few government insurance schemes cover critical illness | Most private schemes cover critical illness as per the policy inclusions |
| Ease of claiming benefit | Claims can take weeks or months to process because of bureaucratic processes | Claims can take few weeks only if the claim is not raised during waiting period |
If the senior citizen is suffering from any complex disease such as a cardiovascular illness that would need critical surgery, he is likely to go with private healthcare insurance. For example, if your team has an elderly employee who suffers from a critical disorder, it is best to choose a healthcare plan that will cover it at minimal cost. This will be different in the case of a family that is living on low income. Low-income earning families would preferably choose a senior citizen health insurance scheme by Government of India because of no premium, transportation cost coverage, and coverage for major critical illnesses.
An elderly citizen can avail both in reality. For example, if a senior citizen is covered under the PM-JAY scheme, they can also avail the benefits of a private insurance scheme.
For primary treatment, an elderly person can avail of the benefits of PM-JAY, while for complex cases such as critical illness coverage, private insurance can be a better choice. A senior citizen can keep two plans running at the same time, and pay for the premium of only the private health insurance.
Coverbiz provides an affordable plan for insuring your team that comes with multiple coverage options and complete cashless hospitalization options.
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Affordability Government schemes are either free or available at very affordable rates per year. The reason for this is to design the schemes so that lower-income classes can afford them easily.
Cashless Coverage Most government-aided insurance schemes provide cashless hospitalization, which is a great benefit as families can immediately get admitted without worrying about cash deposition
Inclusion of Chronic Illnesses Many government-sponsored schemes offer the inclusion of chronic diseases too.
No Commercial Motive Government-aided schemes aim to improve the quality of life and provide insurance facilities rather than any commercial motive
Mental Health Services Very few government plans also offer mental healthcare facilities, which many private plans would cover at a higher rate of premium
Family Support Most of the government schemes work on a family floater basis, and cover the entire family irrespective of the number of members involved
Moreover, schemes like PM-JAY are expanding their reach. As per NHA data, over 9 crore hospitalizations were done under the PM-JAY scheme in 2025.
Government health insurance for senior citizens in India has protected crores of families from critical diseases over the years. For elderly people who are highly susceptible to critical illness and fatal disorders such as heart attacks or kidney issues, government schemes can be a highly economical way to get insured. We have covered the majority of these schemes that are currently active in 2025 and have further classified them according to their central and state-specific application. The Indian government is slowly expanding the scheme benefits, and shortly, the healthcare gap will be bridged for India’s senior population.
There are multiple Central government as well as state government-run health insurance schemes for senior citizens to avail of. Schemes such as PM Jan Arogya Yojana, Pradhan Mantri Suraksha Bima Yojana, and a few more offer better coverage at a much lower premium.
This scheme is maintained under the PM Jan Arogya Yojana (PM-JAY) scheme, which offers health insurance for ₹5 lakhs to the beneficiary of the scheme. This scheme is meant for senior citizens aged above 70 years, and such citizens need to have the Ayushman Vay Vandana Card to access benefits.
There is no specific eligibility required to be covered under this scheme, as the scheme lists anyone who is a citizen of India and has valid identity documents to be eligible.
The PM-Jay scheme offers a total ₹5 lakhs worth of health insurance per family along with other benefits such as 3 days of pre-hospitalization and 15 days of post-hospitalization care. The scheme also covers more than 1900 medical procedures, in addition to covering ICU charges as well.
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