Conditional Protection in a Time of Crisis: Beneficiary Experiences of Ayushman Bharat– PMJAY During the COVID-19 Pandemic in India

The COVID-19 pandemic exposed significant vulnerabilities in health systems, particularly for economically and socially marginalized populations. In India, the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was positioned as a critical mechanism for financial risk protection during the pandemic. This study examines how AB-PMJAY functioned during COVID-19 from the perspective of beneficiaries, focusing on access to healthcare, financial protection, and systemic responsiveness. Using a qualitative research design, in-depth interviews were conducted with AB-PMJAY beneficiaries affected by COVID-19 in Dakshina Kannada district, Karnataka. Thematic analysis was employed to capture beneficiaries’ lived experiences of utilizing the scheme under crisis conditions. The findings reveal that AB-PMJAY provided substantial financial relief and reduced psychological distress for beneficiaries who were able to access empanelled hospitals, enabling timely hospitalization and care without catastrophic out-of-pocket expenditure. However, the study also identifies significant barriers to utilization, including limited awareness, administrative complexity, lack of frontline support, and severe healthcare infrastructure constraints during peak pandemic waves. As a result, formal entitlement did not consistently translate into equitable access. Interpreted through social justice, strengths-based, and systems perspectives, the findings highlight the conditional effectiveness of AB-PMJAY during COVID-19. The study underscores the need for improved awareness, simplified procedures, and stronger institutional coordination to enhance the resilience and equity of publicly funded health insurance schemes during future public health emergencies.