With the government expanding Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) to cover all senior citizens aged 70 years and above, many families are confused about how the coverage limits actually work, especially in joint family setups.
A common question now being asked is if both paternal and maternal grandparents (all above 70 years) live in the same household, does the family get Rs 15 lakh coverage under Ayushman Bharat?
The short answer is no. Even in such cases, the total cover does not go up to Rs 15 lakh. Here’s a simple and clear explanation of how the limits work.
How Ayushman Bharat coverage works for families
Under PM-JAY, eligible families get Rs 5 lakh health cover per family per year for secondary and tertiary hospitalisation. There is no cap on family size, and all members – regardless of age or gender — are covered under this basic limit.
In October 2024, the government expanded the scheme to include all senior citizens aged 70 years and above, irrespective of income or socio-economic status. This senior citizen-focused benefit is implemented through the Ayushman Vay Vandana Scheme. As of December 2025, over 93 lakh Ayushman Vay Vandana cards have already been issued across states and Union Territories.
What extra benefit do senior citizens get?
If a family is already covered under PM-JAY and has members aged 70 years or above, those senior citizens get an additional exclusive top-up cover of Rs 5 lakh per year.
So effectively Rs 5 lakh – regular PM-JAY family cover
Rs 5 lakh – additional cover exclusively for senior citizens (70+)
This takes the maximum coverage to Rs 10 lakh per family, but not beyond that.
What if your both paternal and maternal grandparents live together?
This is where most of the confusion arises. Many assume that since there are two sets of grandparents, the family should get Rs 5 lakh (basic cover), Rs 5 lakh for paternal grandparents and Rs 5 lakh for maternal grandparents. So the total they should get is Rs 15 lakh, but that’s not the case here. And, this assumption is entirely incorrect.
According to the official FAQs on the Ayushman Bharat portal, the senior citizen cover under the Vay Vandana Scheme is also provided on a family basis, not per individual or per set of grandparents.
Even if both paternal and maternal grandparents are over 70 and all of them live in the same household.
The Rs 5 lakh senior citizen cover is shared among all senior citizens in that family.
This is clearly stated in the official FAQ:
“Both your grandparents will be covered, but the Rs 5 lakh annual limit is shared between them as part of the same family.”
Final coverage limit in such cases
So, even in a large joint family with multiple senior citizens aged 70 and above Rs 5 lakh will be regular PM-JAY family cover, Rs 5 lakh senior citizen top-up under Vay Vandana. So, the total maximum coverage stands at Rs 10 lakh per year.
So, Rs 15 lakh coverage is not allowed.
Other important points senior citizens should know
-Senior citizens above 70 remain eligible even if they already have private health insurance or are covered under ESIC.
-Retired government employees with CGHS can enrol, but they must choose between CGHS and PM-JAY—both cannot be used together.
-Once a government health scheme is surrendered to opt for PM-JAY, the decision cannot be reversed.
-Separate enrolment for each senior citizen is not required. Family members aged 70+ can be added using the “Add Member” option.
-A separate Ayushman card is issued to every eligible senior citizen.
-Applications can be made online through the official beneficiary portal or the Ayushman mobile app.
Summing up…
Even if both maternal and paternal grandparents aged 70 or above live under one roof, Ayushman Bharat does not provide Rs 15 lakh coverage. The scheme clearly caps the benefit at Rs 10 lakh per family per year—Rs 5 lakh basic cover plus Rs 5 lakh senior citizen top-up, shared among all eligible elderly members.
Understanding this distinction is important to avoid false expectations while planning healthcare expenses for senior family members.