Czechia exhibits lower catastrophic health spending than many EU countries, but the poorest quintile and older adults still face high out-of-pocket costs, primarily for outpatient medicines. Gaps in coverage—limited co-payment protections, inadequate adult corrective lens support, dental service barriers, long waits, and informal payments—undermine financial protection. Policy efforts should target avoidable co-payments, expand dental and medical product coverage, address waiting times and extra billing, and broaden insurance revenue to fund an aging population.