This study examines how health insurance affects medication adherence among Moroccan adults with hypertension and diabetes, with implications for healthcare system performance and resource allocation. Using data from the 2018 Moroccan National Health Survey, we employed propensity score matching to establish causal relationships between insurance coverage and adherence behaviors across different insurance schemes (CNOPS for employees in the public sector, CNSS for private sector employees, and RAMED for economically disadvantaged populations). Results demonstrate that insurance significantly increased adherence rates for hypertension (5%) and diabetes (3.4%), with systematic variations across schemes. For hypertension, the public sector RAMED program showed the highest effectiveness (6.3%), while for diabetes, the CNSS demonstrated superior outcomes (5.2%). Insurance effects were amplified among lower-wealth populations (8.5% vs 5.2% for hypertension), suggesting important socioeconomic heterogeneity. These findings provide evidence for healthcare system optimization through strategic insurance design. The differential effectiveness across schemes and populations highlights the importance of targeted approaches in healthcare financing mechanisms. Our results inform healthcare delivery system design by quantifying how financial protection influences patient behavior, offering operational insights for health administrators seeking to improve treatment outcomes through system-level financial structures, particularly in developing economies undergoing healthcare transformation.