Throughout cardiac rehabilitation (CR), patients receive critical education on cardiovascular risk factor modification. However, limited health literacy may impede maximum understanding of risk factor modification recommendations. Health literacy impacts care in multiple ways including seeking appropriate care, understanding and processing health information, communicating needs, and taking appropriate actions to improve health. Importantly, limited health literacy has been shown to be a predictor of morbidity and mortality, healthcare use, and healthcare costs. At VA Pittsburgh, phase 2 CR patients complete a baseline health literacy assessment using the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM- SF). Limited health literate patients have shown lower baseline and final functional assessment scores. Based on data from the VA Pittsburg CR program, the association between health literacy and functional outcomes will be presented, alongside a discussion of how to efficiently assess health literacy in CR. Methods for tailoring education delivery to overcome limited health literacy such as use of teach-back methods, adaptation of education materials, and use of plain language recommendations will be presented. Special emphasis will be placed on how cognitive impairment may impact associations between health literacy and outcomes and practice considerations for aging patients.