Knee Replacement Surgery Under ABHA / Ayushman Bharat

Dear Giri Prsad Ankam Ji,

Knee pain and difficulty in walking can seriously affect daily life, especially in older age when movement becomes painful and uncomfortable. It is completely understandable to ask whether knee replacement surgery can be done free under ABHA or Ayushman Bharat and how the process works. The good thing is that many eligible patients are able to receive financial support for knee replacement treatment under government healthcare schemes.

Important Difference Between ABHA and Ayushman Bharat

Many people think the ABHA card itself provides free treatment, but actually:

• ABHA (Ayushman Bharat Health Account) is mainly a digital health ID used to store and manage medical records.
• Free or cashless treatment benefits are usually provided under Ayushman Bharat PM-JAY for eligible beneficiaries.

So, knee replacement coverage mainly depends on PM-JAY eligibility and hospital empanelment.

Is Knee Replacement Surgery Covered?

Yes, knee replacement surgery is generally covered under Ayushman Bharat PM-JAY for eligible patients at empanelled hospitals. Many hospitals provide cashless treatment packages for knee replacement procedures.

Coverage may include:

• Hospital admission
• Surgery charges
• Implant cost
• ICU and hospital stay
• Basic investigations
• Doctor consultation during admission

Some reports mention that PM-JAY packages may have predefined limits or conditions depending on the procedure and hospital.

How to Approach for Knee Replacement Under Ayushman Bharat

Step 1: Check Eligibility

First confirm whether the patient is eligible under PM-JAY.

You can verify through:

• Ayushman Bharat Official Portal
• Hospital Ayushman help desk
• Common service centres (CSC)

Step 2: Find an Empanelled Hospital

Visit the official portal and open “Find Hospital”.

Select:

• State
• District
• Specialty – Orthopaedics

Then check hospitals offering knee replacement treatment under the scheme.

Step 3: Carry Required Documents

Usually these documents are needed:

• Ayushman card or PM-JAY ID
• Aadhaar card
• X-ray or MRI reports
• Previous prescriptions
• Doctor consultation papers

Step 4: Orthopaedic Evaluation

The orthopaedic surgeon will examine:

• Severity of arthritis or knee damage
• Walking difficulty
• X-rays and investigations
• Overall health condition

Doctors decide whether surgery is medically necessary.

Step 5: Package Approval Process

The hospital Ayushman desk usually helps with:

• Document verification
• Online approval process
• Package confirmation
• Cashless admission guidance

Important Things to Remember

Sometimes hospitals may ask for extra charges if:

• The implant selected is outside package limits
• The treatment is not fully covered
• Special room upgrades are requested

If any additional payment is asked, it is important to request proper written clarification and billing details.

How HexaHealth Can Assist You

• Eligibility Check: We can help you check your eligibility for the Ayushman Bharat PMJAY scheme.
• Hospital Network: HexaHealth has a vast network of top hospitals empanelled under the Ayushman Bharat scheme for knee replacement surgery. We can help you find the best one near you.
• Expert Consultation: We can connect you with experienced orthopaedic surgeons who specialize in knee replacement surgery.
• Seamless Process: Our team will guide you through the entire process, from understanding your eligibility to hospital admission and discharge, ensuring a hassle-free experience under the Ayushman Bharat scheme.
• Financial Guidance: We provide support in navigating the financial aspects and ensuring you fully utilize your scheme benefits.

Please do not ignore severe knee pain if walking and daily activities are becoming difficult. Timely evaluation can help doctors decide the best treatment approach.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth