OBJECTIVE: To update research on Medicare payments in the last year of life. DATA SOURCES: Continuous Medicare History Sample, containing annual summaries of claims data on a 5 percent sample from 1978 to 2006. STUDY DESIGN: Analyses were based on elderly beneficiaries in fee for service. For each year, Medicare payments were assigned either to decedents (persons in their last year) or to survivors (all others). RESULTS: The share of Medicare payments going to persons in their last year of life declined slightly from 28.3 percent in 1978 to 25.1 percent in 2006. After adjustment for age, sex, and death rates, there was no significant trend. CONCLUSIONS: Despite changes in the delivery of medical care over the last generation, the share of Medicare expenditures going to beneficiaries in their last year has not changed substantially.