Crossing Thresholds Twice: How Migration and Age Converge to Shape Health Insurance Exclusion among Older Women in Urban India

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DOI: https://doi.org/10.5281/zenodo.21294225

Paramanand Rajwar, Shukkoor T, and Pravin Jadhav (Department of Humanities and Social Sciences, Institute of Infrastructure Technology Research and Management (IITRAM), Ahmedabad, Gujarat)

In October 2024 the Government of India extended its flagship publicly funded health insurance scheme, Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), to all citizens aged seventy years and above, issuing them a new Ayushman Vay Vandana Card (AVVC). The scheme is described in policy documents as ‘universal’. As of December 2025, however, despite 6 crore people being eligible for the benefit card, only 96.73 lakh cards have been issued, accounting for 16 percent coverage. Even though half the beneficiaries were women, they constituted only 38 percent of successful hospitalizations. It is important to note that interstate migrants were not mentioned anywhere in policy documents. The paper explores the role of age and mobility dynamics in the creation of the experience of marginalization among older migrant women in the urban environment of Greater Mumbai. The paper uses a mixed-method approach that involves the analysis of survey data obtained from LASI 2017-2018 (n = 802 women), as well as a thematic analysis of 42 policy-related documents. The results indicate that migrant women are more marginalized in terms of their awareness (24.1% compared to 56.7%), enrollment (18.6% compared to 41.2%) and utilization of services offered by hospitals (4.5% compared to 14.3%). Some of the major challenges here include the lack of Aadhar with the present location, along with not having a personal cell phone.