Over the last two decades research has indicated an unpleasant experience for the elderly with exemptions. An important question for this paper is whether the unpleasant exempted experience for the elderly in accessing health services is linked to illiteracy. Since illiteracy can affect how services are used and its results, the answer to this paper's question could affect how health services are accessed and their associated outcomes. Policy implementors are operating without a solid knowledge of this relationship. The study used a mixed methods approach. Purposive random sampling was applied to select 879 elderly and was guided by research assistants in filling in the questionnaires. Also, purposive sampling was used to recruit 23 key informants. Results indicates a significant relationship between illiteracy and selected indicators of health service access: awareness, acceptability and adequacy. This paper argues for more training opportunities through non-formal programs among adults and communication capacity building among health providers based on the results of implementing the elderly exemption policy in Ubungo and Mbarali districts in Tanzania.