Objective: This study examines temporal trends in hip fracture related utilization and outcomes among elderly fee-for-service Medicare beneficiaries. Method: The study uses claims data for a 5% sample of Medicare beneficiaries with an incident hip fracture hospitalization between 2000 and 2008. We present annual mean patient characteristics, health services utilization, and outcomes and use ordinary least squares regressions to examine adjusted trends in utilization and outcomes after controlling for changes in patient characteristics. Results: We observe a statistically significant temporal decline in inpatient acute days and a statistically significant increase in inpatient post-acute days following hip fractures. In models that control for patient characteristics, we observe statistically significant declines in 1-year hip fracture readmission and mortality rates. Rates of nursing home residence 1-year following fracture were unchanged and remain high. Discussion: Hip fractures remain highly debilitating events and pose significant challenges for the financing of public health insurance programs. © The Author(s) 2014.