This study examined out-of-pocket (OOP) spending and catastrophic health costs among tuberculosis (TB) and HIV patients in Bandung and Yogyakarta, Indonesia, during the COVID-19 pandemic using a mixed-methods approach. About 5.13% of households faced catastrophic health spending, with nonmedical costs forming the largest share. Higher expenses were linked to care in Yogyakarta, treatment at public hospitals, and lack of insurance, while patients coped through borrowing, family help, and asset sales.