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In Slovakia, catastrophic health spending is lower than in many EU countries but has been rising, disproportionately affecting low-income households and older people, mainly due to out-of-pocket spending on outpatient medicines. Despite a comprehensive benefits package, gaps in coverage persist, with complex co-payment rules, limited protection for low-income working-age people, restricted publicly financed dental care, and very limited access for groups such as uninsured individuals, asylum seekers, and undocumented migrants. Strengthening financial protection will require simplifying and expanding exemptions from co-payments, ensuring access to medicines, improving dental care coverage, and addressing inefficiencies that drive people to pay out of pocket for services that should be covered.