Ayushman Bharat, and its flagship component the Pradhan Mantri Jan Arogya Yojana, or PMJAY, is one of the largest publicly funded health insurance schemes in the world. Its goal is straightforward: to make sure that no family, particularly vulnerable ones, is pushed into financial hardship because of medical expenses. Understanding how this scheme actually works, and how far it has come since launch, is useful for patients trying to make use of it, for hospitals deciding whether to empanel, and for anyone tracking India's broader public health policy direction.
How the scheme is structured
At its core, PMJAY provides eligible families with health coverage for secondary and tertiary care hospitalisation, meaning the more serious, often more expensive treatments that would otherwise represent a significant financial shock for a lower income household. Coverage is cashless and paperless at the point of care for empanelled hospitals, meaning a beneficiary does not need to pay upfront and then seek reimbursement, a design choice that matters enormously for families who simply do not have large sums of money available in an emergency.
The scheme sits within the broader Ayushman Bharat framework, which the Government of India has positioned as the core pathway to achieving Universal Health Coverage, ensuring that every citizen, especially vulnerable families, receives affordable, quality healthcare throughout the care continuum, from primary care through to complex tertiary treatment.
The scale of the programme today
As of late 2025, more than 42.7 crore Ayushman Cards have been issued nationwide, with roughly 84,000 new cards being created every single day, a pace that reflects both continued outreach efforts and growing public awareness of the scheme. Under the scheme, 32,544 hospitals are currently empanelled, split almost evenly between public and private facilities, with 17,037 public and 15,507 private hospitals participating overall. That balance matters, since it gives beneficiaries meaningful choice in where they seek treatment rather than being restricted purely to government facilities, which in many regions face capacity constraints.
The government backed the scheme with a budget of 9,406 crore rupees in the Union Budget 2025 to 2026, an increase of nearly 29 percent over the previous year's allocation, underlining the programme's growing priority within national health policy and suggesting continued expansion in coverage and capacity over the coming years.
What full implementation can look like: the Bihar example
Individual states are showing what full implementation can look like when a programme like this is executed well. Bihar, for example, has achieved 100 percent coverage of all eligible families, with more than four crore Ayushman Cards issued in the state. This has translated into real, measurable savings of over 1,000 crore rupees in out of pocket healthcare expenses for Bihar's residents within a single year, a figure that represents actual money that families were able to keep rather than spend on hospital bills. Bihar has also secured the top rank nationally for its implementation of the Ayushman Bharat Digital Mission, showing that strong outcomes on the insurance side and the digital infrastructure side tend to reinforce each other.
The digital layer behind the scheme
That digital layer matters just as much as the insurance coverage itself, and it is worth understanding as its own component. The Ayushman Bharat Digital Mission is building interoperable health records for every citizen through key registries, including the Ayushman Bharat Health Account, commonly known as ABHA, along with a healthcare professional registry, a health facility registry, and a national drug registry. As of November 2025, over 51 lakh Reproductive and Child Health IDs have already been linked to ABHA IDs, including both newly created ABHA IDs and links made through existing ones.
The practical value of this digital infrastructure is that it allows a patient's health records to move with them, so a hospital in one state can access relevant medical history for a patient who was previously treated in another state, reducing duplicate testing, improving continuity of care, and giving doctors a more complete clinical picture when making treatment decisions.
The road ahead and continuing challenges
Despite the scale already achieved, the scheme continues to face real implementation challenges, including ensuring consistent quality of care across the full network of empanelled hospitals, managing claim settlement timelines for hospitals, and continuing to expand coverage into areas where awareness or access to card enrolment remains lower than the national average. The pace of card issuance and hospital empanelment, however, suggests these are being actively addressed rather than left unresolved, and the trajectory over the past several years has been consistently upward.
How PMJAY compares to health coverage models elsewhere
It is useful to place PMJAY in context against other large scale public health coverage models around the world, since India's approach reflects some deliberate design choices worth understanding. Unlike a fully nationalised health system where the government directly owns and operates the majority of hospitals, PMJAY takes an insurance based approach, extending coverage to beneficiaries that can be used at both public and private empanelled hospitals. This hybrid model was a deliberate choice, allowing the scheme to leverage India's substantial existing private hospital capacity rather than requiring the government to build sufficient public capacity from scratch to serve the entire eligible population, which would have taken considerably longer and required substantially more capital investment upfront.
This design also creates a form of competition between public and private empanelled hospitals for patients covered under the scheme, since beneficiaries can generally choose where to seek treatment. In principle, this competitive dynamic should push empanelled hospitals, both public and private, toward better service quality and more efficient care delivery, since PMJAY patients are not captive to a single assigned facility the way beneficiaries of some other national health systems sometimes are.
What hospitals should know about PMJAY empanelment
For private hospitals considering PMJAY empanelment, the decision involves weighing predictable patient volume and government backed payment against the administrative requirements of scheme participation and the reimbursement rates set for different procedures, which do not always match a hospital's standard private pricing. Hospitals that empanel successfully tend to build dedicated administrative teams specifically focused on scheme related billing, documentation, and claims follow up, treating PMJAY patient volume as a distinct operational workflow rather than trying to handle it identically to fully private paying patients. Hospitals in Tier II and Tier III cities, where scheme covered patients often represent a larger share of the addressable patient base than in major metros, have particular reason to invest in getting this operational process right.
How patients can check their eligibility and enrol
For patients trying to understand whether they qualify for Ayushman Bharat coverage, eligibility is generally determined through the Socio Economic Caste Census data and specific deprivation and occupational criteria set for rural and urban households respectively, rather than a simple income threshold alone. Eligible families can check their status and generate their Ayushman Card through Common Service Centres, empanelled hospitals, or the official Ayushman Bharat mobile application, and the process has been deliberately simplified over successive years to reduce the paperwork burden that historically made enrolment in large government schemes a slow and confusing process for many families, particularly those with lower literacy levels.
Frequently asked questions
How many Ayushman Cards have been issued in India?
As of late 2025, more than 42.7 crore Ayushman Cards have been issued nationwide, with roughly 84,000 new cards being created every day.
How many hospitals are empanelled under Ayushman Bharat PMJAY?
A total of 32,544 hospitals are currently empanelled under the scheme, including 17,037 public hospitals and 15,507 private hospitals.
What is the Ayushman Bharat Digital Mission?
It is the digital infrastructure component of Ayushman Bharat, building interoperable electronic health records for every citizen through registries including the Ayushman Bharat Health Account, the healthcare professional registry, the health facility registry, and a drug registry.
Which state has performed best under Ayushman Bharat?
Bihar has achieved 100 percent coverage of all eligible families and secured the top national rank for implementation of the Ayushman Bharat Digital Mission, with residents saving over 1,000 crore rupees in out of pocket expenses within a year.
What is the government's budget allocation for PMJAY?
The Union Budget 2025 to 2026 allocated 9,406 crore rupees to PMJAY, an increase of nearly 29 percent from the previous year's budget.
What comes next for the scheme
Looking ahead, the natural next phase for Ayushman Bharat involves deepening rather than simply widening coverage, expanding the range of procedures and treatments covered, increasing reimbursement rates for empanelled hospitals to keep pace with rising treatment costs, and further integrating the scheme with the digital health record infrastructure being built under the Ayushman Bharat Digital Mission. As card issuance approaches saturation among the eligible population, the programme's success is likely to increasingly be measured less by how many people are covered and more by the depth and quality of the care that coverage actually enables.
Key takeaways
Ayushman Bharat represents a genuine shift in how India thinks about healthcare access, treating it as a right supported by both insurance coverage and the digital infrastructure needed to deliver care efficiently. With card issuance continuing at a rapid daily pace and states such as Bihar demonstrating what strong implementation looks like, the scheme is likely to remain one of the central pillars of Indian health policy for years to come.
