Eight Years of Ayushman Bharat: How India Built a Healthcare Safety Net for More Than 60 Crore People

Eight years after its launch, Ayushman Bharat has grown from an ambitious health-protection programme into one of the largest publicly financed healthcare systems in the world. What began on September 23, 2018 as an attempt to protect economically vulnerable Indian families from catastrophic hospital bills has expanded into a much wider healthcare architecture connecting primary care, hospital treatment, senior-citizen coverage, digital health records and public-health infrastructure.

On its eighth anniversary on September 23, 2026, Prime Minister Narendra Modi said that more than 60 crore beneficiaries now have access to annual health cover of ₹5 lakh under Ayushman Bharat. He also highlighted another number that captures the scale of the programme beyond hospitalisation: Ayushman Arogya Mandirs across the country have collectively recorded more than 500 crore visits.

The latest detailed government data provide an even clearer picture of how rapidly the system has expanded. As of September 21, 2026, more than 48.51 crore people had already been issued Ayushman cards. By August 31, approximately 13.25 crore hospital admissions worth ₹2.03 lakh crore had been authorised through Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, or AB PM-JAY, with more than 38,000 public and private hospitals forming part of the treatment network.

From a ₹5-Lakh Promise to a Nationwide Healthcare Network

AB PM-JAY was designed around a straightforward principle: a serious illness should not force an economically vulnerable family to sell property, borrow heavily, exhaust its savings or abandon treatment because it cannot pay a hospital bill.

Eligible families receive cashless hospitalisation cover of up to ₹5 lakh per family every year for secondary and tertiary treatment. Unlike many conventional insurance products, the programme places no general restriction on family size, age or gender for eligible families, while pre-existing diseases are covered from the first day. Treatment can be obtained at participating public or private hospitals across India, giving the system nationwide portability.

The current national Health Benefit Package provides cashless services for 1,961 procedures across 27 medical specialties. Treatment packages extend across areas including general medicine, general surgery, cardiology, oncology and other specialised hospital care. The scheme can also cover diagnostics before admission, medicines and consumables during treatment, intensive-care costs and specified post-hospitalisation medicines and follow-up expenses.

This design is especially significant for households with limited savings. The financial shock associated with cardiac surgery, cancer treatment, major trauma or another serious hospital admission can be many times a low-income family’s annual disposable income. Under PM-JAY, eligible treatment is delivered cashlessly at the point of service instead of requiring the family to arrange the entire hospital payment first and seek reimbursement later.

13.25 Crore Hospital Admissions and ₹2.03 Lakh Crore in Treatment

The eight-year statistics demonstrate how far the programme has moved beyond enrolment numbers.

By August 31, 2026, about 13.25 crore hospital admissions had been authorised under PM-JAY, representing treatment valued at approximately ₹2.03 lakh crore. These treatments were delivered through a network exceeding 38,000 empanelled public and private hospitals.

The scale becomes clearer when viewed against PM-JAY’s early years. In February 2021, the scheme had recorded roughly 1.59 crore authorised hospital admissions worth about ₹19,714 crore. The subsequent expansion to more than 13 crore admissions therefore represents a major increase in actual utilisation rather than merely the distribution of beneficiary cards.

The system has also become increasingly portable. By June 30, 2026, around 29.05 lakh inter-state hospital admissions worth approximately ₹8,383.97 crore had been authorised. This means that a beneficiary registered in one part of India can receive eligible treatment at an empanelled institution elsewhere in the country—an important feature for migrant workers, families living near state borders and patients seeking specialised care outside their home state.

Nearly Half of Ayushman Cards Belong to Women

The scale of women’s participation is another important dimension of PM-JAY. Government data from early 2026 showed that women accounted for approximately 49% of Ayushman cards and about 48% of authorised hospital admissions. By that stage, nearly five crore hospital admissions involving women had already been authorised.

The absence of restrictions on family size is relevant here. Earlier household-based insurance structures could disadvantage larger families or create difficult choices over which members were covered. PM-JAY’s family structure was designed so that eligible households did not have to exclude women, children or elderly family members simply because a numerical family ceiling had been reached.

Healthcare Protection Extended to Every Indian Aged 70 and Above

One of the most consequential changes since the original launch has been the extension of PM-JAY to senior citizens.

In 2024, the Union Government expanded the programme to approximately six crore Indians aged 70 years and above belonging to around 4.5 crore families, irrespective of income or socio-economic status. Eligible seniors receive an Ayushman Vay Vandana Card. Senior citizens aged 70 and above who already belong to PM-JAY families receive an additional cover of up to ₹5 lakh specifically for themselves rather than having to share the entire amount with younger family members.

By September 21, 2026, more than 1.36 crore Ayushman Vay Vandana cards had been created.

The expansion addresses one of the most difficult areas of household medical finance. Healthcare expenditure generally rises as people age, while private insurance becomes more expensive and may be difficult for elderly people with existing medical conditions to obtain. By making age above 70 itself a qualification irrespective of income, the programme introduced a much wider element of universal entitlement into Ayushman Bharat.

ASHA and Anganwadi Workers Brought Under the Safety Net

Ayushman Bharat has also expanded beyond its original beneficiary database.

In March 2024, approximately 37 lakh families belonging to Accredited Social Health Activists, Anganwadi Workers and Anganwadi Helpers were added to the programme. By September 21, 2026, more than 44.81 lakh Ayushman cards had been generated for ASHAs, Anganwadi Workers, Anganwadi Helpers and eligible members of their families.

These workers form the grassroots layer of India’s health, maternal-care, child-care and nutrition systems. Extending hospital financial protection to them therefore brought a large body of frontline social-sector workers and their families within the same healthcare framework they help deliver to other citizens.

Ayushman Bharat Is More Than Hospital Insurance

The wider significance of Ayushman Bharat becomes apparent only when PM-JAY is viewed alongside the programme’s primary-care component.

India now has approximately 1.87 lakh functional Ayushman Arogya Mandirs, created largely by transforming and strengthening Sub-Health Centres, Primary Health Centres and urban health facilities. The official Ayushman Arogya Mandir portal reported 1,87,102 functional centres as of September 21, 2026.

These centres are intended to move the health system beyond treating illness only after a patient reaches hospital. They provide or support maternal and child healthcare, immunisation, screening and management of non-communicable diseases, reproductive health services, medicines, diagnostics, teleconsultation, wellness activities and preventive healthcare.

By August 2026, government figures showed that these centres had already recorded more than 540 crore cumulative visits. The Prime Minister consequently described the eight-year milestone as one in which healthcare was increasingly being taken closer to people’s doorsteps.

This creates a two-level financial-protection architecture. Ayushman Arogya Mandirs are intended to make routine and preventive healthcare available close to communities, while PM-JAY provides financial protection when eligible patients require expensive secondary or tertiary hospital treatment.

India’s Digital Health Backbone Is Expanding Alongside Ayushman Bharat

A parallel transformation is taking place through the Ayushman Bharat Digital Mission.

By August 12, 2026, 96.43 crore Ayushman Bharat Health Account numbers had been created. More than 110 crore health records had been linked with ABHA accounts, while more than 5.47 lakh health facilities and 10.50 lakh healthcare professionals had been registered within the digital ecosystem.

The objective is not simply to create another identification number. ABHA is intended to allow patients, with appropriate consent, to connect and manage health information across healthcare providers. Over time, this can reduce fragmentation between hospitals, laboratories, clinics and other institutions while making healthcare records more portable.

Combined with PM-JAY’s nationwide portability, this digital infrastructure represents an attempt to create a healthcare system in which both financial entitlement and health information can follow the patient rather than remaining tied to a single hospital or location.

The Bigger Financial Story: Indians Are Paying a Smaller Share Directly From Their Pockets

Perhaps the most important long-term measure of healthcare reform is the amount households must pay directly when somebody falls ill.

India still has substantial out-of-pocket healthcare expenditure, and PM-JAY cannot alone be credited for the improvement. Nevertheless, National Health Accounts show a pronounced change in the financing structure of Indian healthcare.

Out-of-pocket expenditure represented 64.2% of India’s total health expenditure in 2013-14. By 2022-23, it had declined to 43.4%. During the same period, government health expenditure rose from approximately ₹1.30 lakh crore to ₹3.85 lakh crore, while the government’s share of total health expenditure increased from 28.6% to 43.7%. Government expenditure on primary healthcare increased from around ₹50,000 crore to approximately ₹1.4 lakh crore.

Government health expenditure per person also rose substantially, reaching ₹2,786 in 2022-23 compared with ₹1,042 in 2013-14 under the latest National Health Accounts series.

The Economic Survey had earlier estimated healthcare savings exceeding ₹1.25 lakh crore associated with the expansion of publicly financed healthcare and insurance arrangements including Ayushman Bharat.

These numbers do not mean that the problem of medical expenditure in India has disappeared. With households still directly financing more than two-fifths of total healthcare expenditure in the latest National Health Accounts, reducing medical expenses remains a major public-health challenge. What has changed is the direction of travel: a progressively larger share of healthcare financing is being absorbed collectively rather than being paid directly by patients at the moment they become sick.

India and the United States: Two Very Different Models of Medical Financial Risk

The contrast with the United States is particularly instructive because America possesses some of the world’s most advanced hospitals, pharmaceutical companies, medical universities and clinical technologies, yet healthcare affordability remains a serious concern for many households.

The American system should not be described as one without public healthcare support. Medicare provides coverage primarily to older Americans and certain disabled people, Medicaid supports eligible low-income populations, the Affordable Care Act created subsidised insurance marketplaces, and a majority of Americans obtain insurance through employers.

Yet the structure is very different from PM-JAY’s cashless entitlement for covered hospital procedures. American private insurance commonly involves premiums, deductibles, copayments and coinsurance that leave patients responsible for significant amounts even after they have insurance.

According to the U.S. Census Bureau’s September 2026 report, 26.7 million Americans—7.9% of the population—were uninsured throughout 2025. Employment-based insurance remained the largest source of coverage, covering 53.5% of the population for at least part of the year. Medicare covered 20.1%, Medicaid 17.1%, and directly purchased insurance 10.5%.

The United States simultaneously spends an extraordinary amount on healthcare. Official Centers for Medicare & Medicaid Services figures show that American healthcare expenditure reached approximately $5.3 trillion in 2024—$15,474 for every person in the country. Healthcare consumed about 18% of U.S. GDP. Direct out-of-pocket spending alone amounted to approximately $556.6 billion.

High national spending therefore does not automatically mean that individual households are insulated from medical costs.

Even Insured American Families Can Face Thousands of Dollars Before Coverage Fully Responds

Employer-sponsored health insurance illustrates the difference particularly clearly.

KFF’s 2025 Employer Health Benefits Survey found that average annual premiums for employer-sponsored family coverage had reached $26,993. Workers themselves contributed an average of $6,850 towards those family premiums.

Among workers whose insurance included a general annual deductible, the average deductible for individual coverage was $1,886. Eighty-eight per cent of covered workers were enrolled in plans requiring a general deductible before most services were covered. Employees of smaller businesses faced an average individual deductible of $2,631.

A deductible is only one component of possible patient expenditure. Depending on the insurance contract, patients may subsequently face copayments or a percentage of treatment costs through coinsurance until they reach the plan’s annual out-of-pocket limit.

That produces a fundamentally different experience from an eligible PM-JAY treatment package where the objective is cashless hospital treatment at the empanelled facility and the patient is not supposed to finance the covered hospital bill at the point of service.

Medical Debt Exists Even Among Americans Who Have Insurance

Perhaps the strongest illustration comes from medical debt.

A September 2026 Commonwealth Fund study examining working-age Americans continuously covered by private insurance found that 32% were paying medical bills or medical debt over time. Among those carrying medical debt, 46% owed at least $2,000. Hospital treatment was the most frequently cited source of the debt.

The consequences went well beyond the hospital bill. Among privately insured adults with medical debt surveyed, 37% said they had depleted some or all of their savings, while 30% reported delaying or avoiding necessary healthcare because of the cost.

These figures are important because they demonstrate that the affordability problem in the United States is not confined to people without insurance. Insurance can substantially reduce financial risk, but premiums, deductibles, exclusions, coinsurance and uncovered expenses can still leave insured households responsible for large bills.

This is where Ayushman Bharat’s design represents an important alternative for its intended population. Rather than asking an economically vulnerable beneficiary to purchase a commercial policy and then meet a substantial deductible, PM-JAY operates as a government-financed health assurance entitlement offering cashless treatment for covered procedures within its network.

₹5 Lakh Means Something Different When the Beneficiary Pays No Premium

The ₹5 lakh figure must also be understood in the context of the households for whom PM-JAY was originally designed.

For a prosperous household, ₹5 lakh may represent a manageable insurance limit. For a low-income family whose savings may amount to only a fraction of the cost of major surgery, the difference between receiving a hospital demand for several lakh rupees and presenting an Ayushman card can determine whether treatment is pursued at all.

The beneficiary does not pay an annual commercial insurance premium for PM-JAY eligibility. Pre-existing conditions do not face the type of waiting period commonly associated with many retail insurance products, and beneficiaries can obtain covered treatment through the national empanelled network.

That financial architecture is arguably the programme’s most important achievement: it transfers at least part of the financial risk associated with major illness away from the individual household and towards a publicly financed risk pool.

Ayushman Bharat Is Still a Work in Progress

Eight years of expansion do not mean that India has completed the journey towards universal healthcare.

Out-of-pocket expenditure remains significant. Specialist availability and hospital capacity vary substantially between regions. The quality and geographical distribution of empanelled hospitals remain important considerations, particularly in rural and remote districts. PM-JAY primarily protects beneficiaries against defined secondary and tertiary hospitalisation expenses rather than eliminating every medical expenditure incurred by a household.

These limitations make the expansion of Ayushman Arogya Mandirs, public hospitals, free medicines, diagnostic programmes, medical colleges, critical-care infrastructure and digital health systems essential complements to PM-JAY rather than optional additions.

The appropriate measure of the programme is consequently not whether every healthcare problem has disappeared, but whether substantially more Indians now possess financial and physical access to healthcare than before the system was established.

On that measure, the numbers after eight years are substantial.

More than 60 crore people have access to the ₹5 lakh health assurance framework. More than 48.51 crore Ayushman cards have been issued. Around 13.25 crore hospital admissions worth ₹2.03 lakh crore have been authorised. More than 38,000 hospitals form the treatment network. Around 1.87 lakh Ayushman Arogya Mandirs are functioning across India. Primary-care footfall has crossed 500 crore visits, while India’s digital healthcare architecture has expanded to hundreds of millions of citizens.

Eight Years That Changed the Economics of Illness

The deeper achievement of Ayushman Bharat lies beyond its enormous numbers.

For generations, serious illness in India carried two dangers simultaneously—the danger to life and the danger to the family’s finances. A hospital admission could consume savings accumulated over years, force families into informal borrowing or leave patients postponing treatment because money could not be arranged.

Ayushman Bharat represents an attempt to break that relationship between illness and financial catastrophe.

The comparison with the United States illustrates why the design matters. America spends more than $15,000 per person annually on healthcare and possesses some of the most sophisticated medical capabilities on Earth, yet millions remain uninsured and significant numbers of insured households continue to report medical debt. India operates with far fewer financial resources, but its policy direction has increasingly emphasised publicly financed primary care and cashless hospital protection for vulnerable families and, more recently, universal eligibility for citizens aged 70 and above.

Ayushman Bharat therefore represents more than a health-insurance programme. PM-JAY, Ayushman Arogya Mandirs, the Ayushman Bharat Digital Mission and the country’s expanding public-health infrastructure are gradually being assembled into a broader healthcare safety net.

Eight years after the first beneficiary entered the system, its most important contribution may be a simple change in expectation: for hundreds of millions of Indians, a serious diagnosis increasingly does not have to begin with the question, “How will we pay the hospital?”

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References

Press Information Bureau, Prime Minister’s Office — “Prime Minister highlights success of Ayushman Bharat on its eighth anniversary,” September 23, 2026.

Press Information Bureau — “Progressing Towards Universal Health Coverage: Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana,” September 22, 2026.

Ministry of Health and Family Welfare / Press Information Bureau — National Health Accounts Estimates for India 2022-23, May 27, 2026.

National Health Authority — Ayushman Bharat PM-JAY programme documents and Health Benefit Package information.

Ministry of Health and Family Welfare — Ayushman Arogya Mandir national dashboard, September 2026.

Press Information Bureau — Affordable and Accessible Healthcare for All, August 12, 2026.

Press Information Bureau — AB PM-JAY parliamentary updates, July-August 2026.

U.S. Census Bureau — Health Insurance Coverage in the United States: 2025, September 15, 2026.

U.S. Centers for Medicare & Medicaid Services — National Health Expenditure Accounts, 2024.

KFF — 2025 Employer Health Benefits Survey.

Commonwealth Fund — How Medical Bills and Debt Impact Americans with Private Insurance, September 17, 2026.

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