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Most Americans facing death are Medicare beneficiaries, yet Medicare's hospice benefit, which provides coverage for palliative care services, is a relatively small program, serving only 20 percent of beneficiaries. Using the Medicare Current Beneficiary Survey, we found that non-whites, low-income individuals, and nursing home residents are less likely than their counterparts to choose hospice care. Drug coverage, insurance status, and treatment protocols can influence an individual's decision to choose hospice care. Some modest changes to the current Medicare program, such as hospice eligibility and improved physician training in palliative care can improve end-of-life care received by dying Medicare beneficiaries.