This case study traces the creation and evolution of Medicare hospice policy. The Medicare hospice benefit, created in 1982, emphasizes palliative rather than curative care. It focuses on quality of life for the dying patient and family and encompasses medical, psychological, and spiritual care. Because no standard hospice care practices existed before this benefit was implemented, Medicare rules almost exclusively dictated the structure and delivery of services. Despite initial concerns about low use, spending averaged 17 percent per year between 1991 and 2001, largely driven by increased enrollment, covered days, services provided, and inflation. A rich accumulation of research studies and analyses of specific aspects of the hospice program provides an opportunity for a retrospective analysis of the program’s genesis, impact on health care delivery, and implications for future policy decisions.