Chronic conditions are more common than you might think.

According to the CDC, 6 in 10 U.S. adults have at least one chronic illness, and 4 in 10 live with two or more. These include long-term conditions like diabetes, asthma, COPD, heart disease and more—many of which require daily management and long-term treatment.

No matter your diagnosis, Marketplace plans are designed to give you full access to the care you need—without barriers tied to your health history. And for people managing chronic illnesses, there are also plan options designed to help lower costs and improve access to the care you need most.

In this guide, we'll take a closer look at how Marketplace plans can support your ongoing care, what benefits to look for and how to choose a plan that works for your specific health needs.

What Is a Chronic Health Condition?

A chronic health condition is any long-term illness or health issue that requires ongoing care, monitoring or treatment. These conditions often develop over time and last for a year or more. They may not have a cure, but with the right care plan—including regular doctor visits, medications and lifestyle support—they can often be managed effectively.

Chronic conditions may:

• Limit your ability to carry out everyday activities
• Require regular check-ins with your doctor or specialists
• Involve routine use of medications, monitoring tools or assistive devices
• Lead to increased medical costs without the right insurance coverage

These conditions are common. In fact, they account for the majority of healthcare use and costs in the U.S., especially among adults.

Examples of chronic health conditions include:

• Diabetes — a condition that affects how your body processes blood sugar and often requires daily medications or insulin
• Asthma or chronic obstructive pulmonary disease (COPD) — chronic respiratory conditions that make breathing more difficult and often require inhalers or ongoing treatment
• Heart disease — such as coronary artery disease, which may require lifestyle changes, medications, and ongoing cardiac care
• High blood pressure — also known as hypertension, which increases the risk of stroke and other complications if not well managed
• Arthritis — joint pain and inflammation that can limit movement and impact daily life
• Chronic kidney disease — a gradual loss of kidney function that may require medication or dialysis in advanced stages
• Depression or other mental health conditions — can impact overall well-being and often require long-term therapy or medication support

If you're living with asthma or COPD, it’s important to understand your insurance options to leverage the proper ongoing care. If you’re managing diabetes, make sure to explore plan recommendations and cost-saving strategies.

Preventive Care and Essential Health Benefits Covered by All Plans

No matter which Marketplace plan you choose, all include essential health benefits that support chronic condition management. While you may have to pay out-of-pocket costs like copays or coinsurance, these services are guaranteed in every plan:

• Routine preventive care at no cost — Including annual wellness exams, routine screenings for chronic diseases, vaccinations (like the flu shot) and dietary counseling.
• Primary care and specialist visits — Plans cover visits to both general practitioners and specialists like pulmonologists, endocrinologists, and other providers relevant to your condition.
• Prescription medications — Coverage includes medications used to manage chronic conditions, such as insulin, inhalers, blood pressure medications and mental health prescriptions.
• Rehabilitation and therapy services — Such as physical therapy, cardiac rehab or respiratory therapy after a hospitalization or flare-up.
• Mental health support — including therapy sessions, counseling and treatment for conditions like anxiety and depression, which often accompany or complicate chronic conditions.

Coverage amounts, copays and coinsurance vary by plan. But every Marketplace plan offers access to the basic services you need to manage your health.

Insurance Plans Designed Specifically for Chronic Health Conditions

Depending on where you live, you may be able to enroll in a health plan designed specifically for people with chronic conditions. These plans are built to better support people who use more care and rely on regular prescriptions, provider visits and testing.

Benefits of condition-specific plans may include:

• $0 copays or lower costs for chronic condition medication and supplies
• Enhanced care coordination including care management programs

These plans are especially helpful for people managing asthma, COPD or diabetes, and may also benefit those with other ongoing health needs. They’re often available as Silver-level plans through the Marketplace and are tailored to provide more value to those who use their coverage regularly.

Plan availability and features vary by state, so it’s worth checking during enrollment to see if condition-specific options are available in your area.

How to Choose the Right Plan for Your Health Needs

Choosing the right plan starts with understanding what you need—and what to look for. Here are a few tips to help you find the best fit:

Look for plans that highlight chronic health condition support

Some plans are labeled to show they’re designed for specific conditions (like diabetes or asthma/COPD). These plans may include special benefits like $0 drug options or condition-specific care coordination.

Use the comparison tool to review plan details

When shopping for plans, use the Marketplace’s comparison tool to review:

• Monthly premiums
• Deductibles
• Copays and coinsurance
• Out-of-pocket maximums

People with chronic conditions typically benefit more from silver or gold plans, which may have high premiums but offer lower costs when they receive care.

Verify that your preferred doctors are in network

If you already have a trusted primary care provider or specialist, make sure they’re included in the plan’s network. Use the provider search tool or contact the insurer directly if needed.

Check the formulary to confirm medication coverage

Each plan has a formulary—a list of covered drugs. Confirm that your regular prescriptions are listed, and which tier they fall into (this affects the cost). If your medications aren’t included, they may not be covered—or could be more expensive.

Questions About Managing Chronic Health Conditions with Marketplace Insurance