Health care reform has caused consumers to learn more about what it means to have health insurance and its costs. Patient engagement, a critical component of health care reform, reflects provider and consumer attention to shared decision making between patient and physician. The problem addressed in this study is that although researchers have studied patient engagement, there has been insufficient exploration of the relationship between financial literacy and patient engagement, which could negatively impact health outcomes not only for patients or consumers but for society as a whole. The purpose of this quantitative research was to determine if a relationship exists between patient financial literacy and patient engagement, as measured by the patient activation measure. The potential effects of increased patient financial responsibility due to high deductible health plans, measured via an item inquiring about participants' deductible, as well as shared decision making between physician and patient were also evaluated as potential moderators between financial literacy and patient engagement. Theories used to provide conceptual context include Shim's cultural health capital theory and Bourbeau's (2008) self-management model. Two hierarchical linear multiple regression models were used to test the research hypotheses. While the research did not find a significant relationship between patient financial literacy and patient engagement, it did confirm the importance of mental health status and patient-physician shared decision making as important predictors of patient engagement. These findings provide a better understanding of financial literacy and specific financial behaviors in the context of healthcare environment today.