Top Schemes of Government Health Insurance For Senior Citizens [2025 Updated]

Why is health insurance required for senior citizens?

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.

IRDAI Regulations for Government Health Insurance for Senior Citizens

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:

• Insurance providers will not revise the premium by more than 10%
• Insurance providers have to consult IRDAI if they wish to increase the premium by 10%
• Insurance providers have to also consult IRDAI if they withdraw any individual health insurance premium offered to senior citizens
• The insurers have to promote the benefits of insurance among senior citizens
• Check for common empanelment of hospitals
• Also, negotiate on the package rates under the Pradhan Mantri Jan Arogya Yojana

The objectives behind these regulations of IRDAI were:

• Create simplified and affordable health insurance for senior citizens
• Financially protect senior citizens against India’s healthcare inflation
• Increase wide coverage for hospital empanelment
• Create insurance awareness among senior citizens
• Put an upper limit on premiums charged by insurers to senior citizens

Read also Pradhan Mantri Swasthya Bima Yojana, its coverage, and its main benefits.

Top Senior Citizen Health Insurance Scheme by Government of India

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.

A) General Insurance Schemes

1. PM Jan Arogya Yojana (PM-JAY)

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.

Features of The Scheme

• Offers insurance over ₹5 lakhs for both secondary and tertiary family members
• Covers both private and public empanelled hospitals
• Covers 3-days pre-hospitalization and 15-days post-hospitalization benefits
• Insures irrespective of family size, age, or the gender of the insured
• Offers cashless treatment at all empanelled hospitals
• Portable scheme and covers hospitals across India

Benefits of the PM-JAY Scheme

• Coverage for diagnosis and pre-hospitalization expenses
• Coverage for medical implantation services
• Provides financial support for medical implantations
• Financially covers all types of medical treatment and consultations
• Covers both intensive and non-intensive care services
• Offers accommodation benefits
• Covers food services
• Covers any complications during medical treatment

The scheme covers over 1,500 medical packages, which include specialized medical treatments and implants such as joint replacement, dialysis, and even cancer treatments.

2. Central Government Health Scheme (CGHS)

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.

Features of The Scheme

• Coverage for specialist treatment at government hospitals
• A large number of hospitals empanelled
• Supports artificial surgeries and implants
• Offers cashless facilities too
• Supports maternity and child services too

Benefits of the CGHS Scheme

• Supports OPD treatment
• Avail medical consultations in Ayurveda, Allopathy and Homeopathy
• Offers family welfare coverage
• Cashless hospitalization benefit
• Reimbursement for treatment in government hospitals
• Coverage for hearing aids, artificial limbs, and more
• Private medical consultation coverage
• Indoor treatment at government hospitals

3. Pradhan Mantri Suraksha Bima Yojana (PMSBY)

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.

Features of The Scheme

• Offers highly low premium insurance
• 1-year insurance coverage
• Covers permanent disability such as loss of eye or foot

Benefits of the CGHS Scheme

• Low premium of only ₹20 to be paid annually
• Insurance benefit of ₹2 lakhs on death of nominee
• ₹2 lakhs insurance benefit for permanent disability
• ₹1 lakh insurance benefit for partial disability

4. Employee State Insurance Scheme (ESIC)

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.

Features of the Scheme

• Offers retirement benefits applicable to senior citizens
• Financial aid for artificial implants and limbs
• Coverage for imaging service
• Supports specialist consultation
• Offers sickness benefit
• Provides financial benefits for disability

Benefits of the Scheme

• Offers funeral benefits of ₹15,000
• Offers sickness benefits to 70% of the wages
• Permanent disability coverage till 90% of wages
• Temporary disability coverage till 90% of wages
• Offers coverage for scans, imaging services, and diagnosis
• Offers sickness benefits for 91 days annually
• Offers extended sickness benefits for 2 years for 34 critical diseases

Read also the cost of LASIK eye surgery in India.

5. Pradhan Mantri Vaya Vandana Yojana (PMVVY)

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:

Features of the Scheme

• Offers loan facility apart from securing health
• Tailored to meet the needs of senior citizens specifically
• Provides 98% surrender value compared to any other schemes
• Comes from LIC, a reputed insurance firm

Benefits of the Scheme

• Has no upper limit in age to enroll
• Offers high return rate on premium paid
• Flexible pension withdrawal after a month, quarterly, or half-yearly
• Provides death benefit after 10 years
• Offers loan at 75% of the purchase price

B. State Level Schemes

6. Yashawini Health Protection Scheme (Karnataka)

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.

Features of the Scheme

• Offers health coverage to self-help groups, cooperative societies, cooperative workers, and corporative fishermen
• Coverage for the eligible family members

Benefits of the Scheme

• Cashless hospitalization benefits
• Benefit of coverage till ₹5 lakhs
• Coverage for diseases related to heart, nose, throat
• No age limitation
• Coverage for both urban as well as rural population

7. Karunya Arogya Suraksha Padhathi (Kerala)

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.

Features of the Scheme

• Cashless hospitalization access
• Around 3 days of pre-hospitalization and 15 days of post-hospitalization coverage
• No limitation on family size and gender
• This scheme covers all forms of pre-existing disease
• Schemes are portable pan India

Benefits of the Scheme

• Provides coverage till ₹5 lakh per family
• Covers 1573 different medical treatments
• Provides coverage for diagnostic and medical examinations
• Covers both non-intensive and intensive care services
• Accommodation expenses covered
• Implantation expenses covered

8. Mahatma Jyotiba Phule Jan Arogya Yojana (Maharashtra)

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.

Features of the Scheme

• Covers all pre-existing illness
• Has dedicated call centers for assisting the beneficiary
• Covers medical treatments under 34 specialties
• No paper was used and a completely digital run scheme
• Emergency admission can be availed through calls

Benefits of the Scheme

• Offers health insurance to ₹1.5 lakh per family
• Coverage for nursing and boarding charges
• Blood transfusion expenses covered
• Expenses related to prosthetics covered
• One-time transport costs covered
• Surgical appliance costs
• ICU Charges cost
• All-inclusive insurance for Maharashtra residents

9. Swasthya Sathi Yojana (West Bengal)

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.

Features of the Scheme

• Covers tertiary and secondary health disorders
• All ophthalmic procedures covered
• Covers pre-existing diseases
• Offers app-based geotagging
• No cost realization from the insurance beneficiary

Benefits of the Scheme

• ₹5 lakh coverage for all sorts of pre-existing diseases
• Smartcard-based healthcare system
• Offers real-time health status tracking
• Has claim reimbursement within 30 days from the insurance provider
• Has an online grievance platform
• No limitations on family size
• Coverage for spouses too

10. Mukhyamantri Amrutum Yojana (Gujarat)

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.

Features of the Scheme

• Covers all the families who lie in the BPL category
• Provides complete health coverage for ASHA workers
• Insurance for cancer patients is available
• Critical accident cases are also insured

Benefits of the Scheme

• Neurosurgery expenses are covered
• Covers newborn diseases
• Provides coverage for eye surgeries
• Covers cardiovascular surgeries
• Cancer is covered
• Cases of accidental burns are covered
• Joint replacements such as knee cap surgeries are covered

11. Bhamashah Swasthya Bima Yojana (Rajasthan)

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.

Features of the Scheme

• Offers cashless hospitalization benefit
• Provides coverage for diagnosis and medicine distribution
• Covers OPD treatments
• Doctor consultation fees are also covered
• Offers transportation coverage
• Post-hospitalization expenses are also covered

Benefits of the Scheme

• Has cashless hospitalization benefit
• Offers coverage for critical illness till ₹3 lakhs
• Transportation coverage till ₹500 per family
• Expenses in case of pots-hospitalization coverage

Also, read the main differences between OPD and IPD treatments.

Difference between Government Health Insurance and Personal Health Insurance

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:

What is the Eligibility Criteria for Senior Citizens Under Government Schemes?

The eligibility criteria for senior citizen health insurance scheme by government of India usually differs, but in general it includes:

• The insured must be more than 60 years old
• The insured must have valid identity proofs
• The insured must carry diagnosis reports and hospitalisation bills
• Few schemes are meant only for government employed senior citizens

Some schemes may require the beneficiary to have a specific occupational category such as domicile workers or cooperative fisherman

Does the Government Health Insurance Scheme Cover Pre-Existing Diseases?

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:

• PM-JAY Insurance Scheme
• Mahatma Jyotiba Phule Jan Arogya Yojana
• Karunya Arogya Suraksha Padhathi
• Swasthya Sathi Yojana
• Bhamashah Swasthya Bima Yojana

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.

Regular Healthcare Plan or Government Healthcare Plan: Which One to Choose?

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.

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.

Can Senior Citizens Avail Both Government and Private Health Insurance?

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.

Covrzy provides an affordable plan for insuring your team that comes with multiple coverage options and complete cashless hospitalization options.

Read also the benefits and process to apply for AYUSH treatment in India.

Benefits of Government Health Insurance for Senior Citizens

• 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.

Conclusion

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.