The health finance debate in 2025 revolves around Ayushman Bharat PM-JAY’s free ₹5 lakh coverage (plus ₹5 lakh extra for seniors) against private health insurance from Star Health or HDFC Ergo. The enlargement of September 2024 included 6 million elderly people in the program, but more than 600 private hospitals have already rejected participation. The Economic Times’ article says: “Cashless treatment in danger!” Therefore, is the government’s free cover good enough, or do you still have to get private insurance?
Coverage & Cost Reality
Ayushman provides totally free ₹5 lakh for inpatient treatment and another ₹5 lakh for those over 70 years of age. Private plans start at ₹5 lakh and go up to ₹50 lakh, covering both inpatient and outpatient (OPD) costs, but seniors need to pay ₹8,000–₹25,000 for one year. Ayushman has a list of 14,412 hospitals, where 66% of them are private hospitals, whereas, on the other hand, over 20,000 hospitals are covered by private insurance companies including the best ones like Apollo and Fortis. Do you need OPD medications and consultations? Only private insurance covers that. Claims statistics indicate that ₹80,000 crore have been processed, with two-thirds done through private hospitals—yet the speed of reimbursement is in favor of private players.
Why Hospitals Are Opting Out
The National Health Authority (NHA) makes clear that private hospitals handle a large chunk of Ayushman hospitalizations—two-thirds to be precise. Nonetheless, payment delays are that long—more than 90 days and also the rates are low—₹500 per day for ICU. In Delhi, for instance, 500,000 cards were distributed (5 lakh cards issued), but the number of patients treated was just 9,000. Cash payments for cancer and heart patients are common. Outlook Money says: “Private hospitals will not be dependent on Ayushman and will be prosperous by themselves.” This moving away from the program will affect treatment accessibility in emergencies.
Smart Solution: 2025 Hybrid Strategy
The experts alternate the order of building Ayushman as a basis and giving private insurance as a top-up. The first step is to enroll in Ayushman Vaya Vandana Card at pmjay.gov.in—it takes only 5 minutes. The second step is to buy a ₹10 lakh top-up policy for ₹12,000 per year to cover OPD and fast claims. Real-life case: Mukesh Ji, a 72-year-old from Delhi, got almost free heart surgery (€4.5 lakh) through Ayushman, while his private policy covered medicines and doctor visits after the surgery.
Conclusion
The inflation rate for healthcare is predicted to be around 15% in 2025, hence Ayushman would be good for inpatient emergencies (free, 34.5 crore cards issued), but it is still inadequate in OPD, premium hospitals and speed. So adopt the hybrid model: take the free government-covered insurance but have the private one for full protection. Poll: Will you go hybrid or stick to one option? Comment now!
