The Ayushman Bharat Yojana, launched in 2018 by the Narendra Modi government, was conceived as the country’s most ambitious publicly funded health insurance programme. With a promise of cashless medical coverage of up to Rs 5 lakh per family every year, the scheme was designed to shield economically vulnerable citizens from the crushing burden of private healthcare costs. In Delhi, the promise was further expanded with an additional Rs 5 lakh cover for residents, reinforcing the idea that serious illness should not push families into poverty.
On paper, Ayushman Bharat offers national portability and access to free secondary and tertiary care across more than 30,000 empanelled hospitals in India. Beneficiaries are meant to receive treatment anywhere in the country without worrying about upfront payments. However, the critical question remains: how far does this promise hold up when patients actually walk into hospitals seeking care?
To test this reality, India Today’s Special Investigation Team conducted an extensive undercover investigation across Delhi-NCR and Chandigarh, along with select hospitals in Punjab and Himachal Pradesh. What emerged from this exercise was a disturbing pattern that points to deep structural flaws in the implementation of Ayushman Bharat, raising serious doubts about its effectiveness on the ground.
At Sushila Hospital in Narela, Outer Delhi, the team enquired about a hip replacement surgery under the Ayushman scheme. Orthopaedic specialist Dr Rakesh Singh initially explained the medical process in detail. However, once it became clear that the treatment would be covered under Ayushman Bharat, his response changed noticeably. He bluntly explained that the scheme’s package rates do not reflect the real cost of surgery.
According to him, Ayushman covers only around Rs 80,000 for a hip replacement, while the implant alone can cost close to Rs 70,000. This leaves virtually nothing to cover surgeon fees, hospital charges, nursing care and post-operative management, which he estimated to be an additional Rs 50,000 to Rs 60,000. He also insisted that such patients must stay in air-conditioned private rooms to prevent infections, costing around Rs 8,000 per day for nearly a week. In reality, this meant that a patient would still have to pay Rs 80,000 to Rs 90,000 out of pocket, despite the scheme’s promise of cashless care.
A similar story played out at the Universal Center of Health Sciences in South Delhi. Even the hospital’s Ayushman Mitra, whose role is to facilitate treatment under the scheme, admitted that getting approval for a hip replacement was nearly impossible. He candidly stated that the package rates simply do not work in practice. Despite repeated attempts to speak to senior doctors, the hospital did not provide any further clarification.
In Ghaziabad, at Jeevan Jyoti Hospital in Pratap Vihar, the reception staff outright claimed that major surgeries are not covered under Ayushman Bharat, contradicting the government’s own empanelment list. Outside the hospital, the team spoke to Ramveer, a TPA manager, who explained the economics behind the refusal. He said hospitals receive only a few thousand rupees in some cases, and the daily medical management allowance is just Rs 300, which is meant to cover room charges, doctor fees and medicines. He added that many large hospitals simply refuse Ayushman patients altogether because the scheme is financially unviable for them.
At Surbhi Hospital in Noida, despite being empanelled for all treatments, Ayushman beneficiaries were accepted only for selective procedures such as hernia operations, gall bladder surgeries and dialysis. When asked about hip replacement surgery, the hospital refused without hesitation.
Across Delhi-NCR, a clear pattern emerged. Patients were routinely discouraged, misinformed or redirected. Hospitals cited low package rates, demanded extra cash for better implants or private rooms, and selectively restricted the treatments available under the scheme. While the poor are technically entitled to care, Ayushman Bharat often functions as little more than a formality in practice.
The investigation then moved to Chandigarh, where the story remained largely unchanged. At Mukat Hospital and Heart Institute, an empanelled facility since 2021, the Ayushman card was initially authenticated. Soon after, excuses followed. Hospital staff claimed that approvals were frequently rejected. The Ayushman Mitra added that outstation patients required central approval and questioned why patients from Delhi were seeking treatment in Chandigarh, directly contradicting the scheme’s promise of national portability. Ultimately, the hospital advised getting total hip replacement done in cash, dismissing Ayushman coverage entirely.
The reality that emerged across Delhi-NCR and Chandigarh was stark. Ayushman Bharat exists largely on paper, while poor patients are routinely denied its real benefits. Many hospitals discourage Ayushman patients, restrict treatment categories, push for out-of-pocket payments and dismiss portability claims. The unspoken message to beneficiaries is simple: meaningful treatment requires cash.
This pattern did not change when the investigation extended to Punjab and Himachal Pradesh. At Indus International Hospital in Mohali, emergency admission for a dengue patient was refused under Ayushman. Staff insisted that emergencies require cash payment and that reimbursement, if approved later, could be claimed afterward. A doctor confirmed that dengue treatment was not covered unless surgery was involved, resulting in denial of admission.
At Bhatia Neuro and Multispeciality Hospital in Patiala, the receptionist claimed that Ayushman had been “shut down” because hospitals were not being paid. The TPA manager admitted that no Ayushman case had been processed in over a year. When confronted, the orthopaedic specialist openly stated that the scheme only covers the cheapest implant and pays surgeons a fraction of what private patients generate, making Ayushman cases unattractive for hospitals.
Similar restrictions were observed at JP Hospital in Zirakpur, where Ayushman was said to cover only dialysis, despite government records stating otherwise. In Solan, Himachal Pradesh, both Navjeevan Nursing Home and Elcura Healthcare cited delayed approvals and pending payments as reasons for refusing Ayushman patients, even in emergencies. One hospital owner admitted being owed nearly Rs 1 crore by the government and advised patients to seek treatment at government hospitals instead.
These findings raise a fundamental question: if empanelled private hospitals are routinely turning away patients, who is truly benefiting from Ayushman Bharat?
Following the India Today investigation, several state governments responded with assurances of strict action. Uttar Pradesh promised zero tolerance against hospitals denying treatment. Delhi’s government said complaints are resolved promptly and pledged to act on the findings. Punjab acknowledged serious financial and structural issues, admitting that current rates are not viable for doctors or insurers and announcing plans for a blended state-level insurance scheme. Himachal Pradesh highlighted funding caps and rising costs as reasons for pendency and delays.
Ayushman Bharat was envisioned as a transformative healthcare safety net for millions of vulnerable Indians. Yet, the investigation reveals a widening gap between policy intent and ground reality. The uncomfortable question now confronting policymakers is whether the scheme, in its current form, is failing the very people it was meant to protect.
