This study explored how women in early adulthood living with chronic illness exercised agency in navigating Ontario's health care system. Eight women aged 18 to 35 took part in semi-structured interviews, analyzed using reflexive thematic analysis. Participants were both highly agentic and highly constrained: they researched their conditions, coordinated between providers, sought second opinions and pursued private, alternative or overseas care, while remaining dependent on clinicians for referrals, investigations and treatment. Many concealed their health knowledge to preserve credibility, understood their health relationally through partners, mothers and online communities, and withdrew from care as self-preservation after repeated dismissal. Employment conditions and the cost of uninsured services shaped what participants could manage. The study characterized this as compensatory care, in which patients absorbed the work of a fragmented system, and argued that reducing patient burden and recognizing patient knowledge were distinct objectives.