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Key Points Question How does use of hospice and hospital services at the end of life differ by race and ethnicity among patients with dementia? Findings This cohort study found that non-Hispanic Black and Hispanic decedents with dementia used less hospice but more emergency department and inpatient services, and incurred roughly 60% higher Medicare inpatient expenditures at the end of life, compared with non-Hispanic White decedents. The proportion of dementia beneficiaries completing advance care planning was significantly lower among non-Hispanic Black and Hispanic decedents compared with non-Hispanic White decedents. Meaning These results highlight the importance of understanding how end-of-life care utilization and treatment preferences among patients with dementia differ across racial and ethnic groups.