The cost of asthma and COPD medication has risen steadily in the past decade—especially for inhalers and maintenance therapies. Fortunately, Marketplace health insurance plans are required to cover pre-existing conditions, including asthma and COPD, and they often provide access to affordable care, prescriptions and specialists.

Whether you’ve been managing one of these conditions for years or are newly diagnosed, Marketplace coverage can help reduce your out-of-pocket costs and give you the tools you need to breathe easier.

Marketplace Insurance Coverage for Asthma and COPD Care

Marketplace insurance plans are built to support people with chronic health needs [link to chronic conditions blog]. All plans are required to cover pre-existing conditions, which include asthma, COPD and other respiratory conditions. This means you can’t be denied coverage or charged more based on your diagnosis.

Marketplace plans generally cover:

• Primary care and specialist visits (including pulmonologists and allergists)
• Prescription medications, including inhalers, steroids, nebulizers and maintenance treatments
• Emergency care and hospitalization, including ER visits or inpatient stays due to severe respiratory events

In most cases, your copay, coinsurance or deductible will apply until you reach your plan’s out-of-pocket maximum (OOP max). It’s also important to know that specialist visits may cost more than visits to a primary care provider, so checking your plan’s benefits can help you estimate your costs in advance.

Save with Insurance Tailored to Asthma and COPD Needs

In addition to standard coverage, some Marketplace health plans are designed specifically for people managing asthma and COPD. These plans are typically available in certain states and may offer unique benefits that lower your overall costs and improve access to the care you use most.

While plan features may vary, some of the benefits may include:

• Lower or no copays for asthma- and COPD-related medications and services
• Extra support for managing chronic respiratory conditions, including virtual visits or care management programs

These condition-specific plans are designed to better match the needs of people living with chronic respiratory conditions—offering more focused coverage and potentially more predictable costs.

When available in your state, these plans can be an excellent choice for managing asthma or COPD while keeping care affordable.

Tips for Choosing the Right Plan for Asthma and COPD Needs

Not sure how to find a plan that fits your needs? These tips can help you make more informed decisions when shopping for or renewing a Marketplace plan:

1. Choose a plan designed for people who use more care
   When you shop on the Marketplace, you’ll be asked how much care you expect to use. People managing asthma or COPD should generally select “medium” or “high” usage so they can see plans that better match their care needs.
2. Consider silver or gold plans for better coverage
   Marketplace plans are divided into metal levels (bronze, silver, gold). While bronze plans have lower monthly premiums, they cover less when you need care.
   For chronic conditions, silver and gold plans are often a better fit. Though they may cost more each month, they typically offer lower deductibles and better coverage for frequent doctor visits, medications and specialist care.
3. Make sure your medications and supplies are covered
   Each plan has a formulary, or drug list, that outlines which prescriptions are covered. Check that your current asthma or COPD medications are included. If your medications aren’t on the formulary, they may not be covered or cost more.
4. Check that your providers are in-network
   If you already have a primary care doctor or specialist you trust, make sure they’re included in your plan’s provider network. You can enter your providers when using the plan comparison tool or check each plan’s provider directory online.
5. Look for condition-specific plans
   Some insurers offer plans designed especially for people with asthma and COPD. These plans may include extra benefits like $0 copays for essential medications, waived deductibles for maintenance drugs, and enhanced virtual care options. If these plans are available in your area, they may offer better cost control and more tailored care.

Questions About Affordable Asthma and COPD Care