Objective: To examine whether use of the Medicare Hospice Benefit between health maintenance organization (HMO) and Fee-For-Service (FFS)- enrolled beneficiaries varies by income or race. Data source: Medicare enrollment and claims data for South Florida. Results: In the FFS system, rate of death in hospice varied by income. In the HMO system, it did not. Time spent in hospice varied by income in the HMO system and not in the FFS system. There was little evidence that racial differences in hospice use differed between FFS and HMO options. Conclusions: These differences raise questions about whether some hospice use may be in response to system-level incentives.