HCA Healthcare, Inc. (HCA) Earnings & Analysis

Latest quarter

HCA Healthcare reported third-quarter revenue of $19.8 billion, above the $19.4 billion consensus. Adjusted earnings were $7.22 per share, above the $6.74 consensus.

The company’s 10-Q shows revenue rose from $19.161 billion in the third quarter of 2025 to $19.849 billion. HCA attributed the increase primarily to a 2.8% rise in equivalent admissions and a 0.7% increase in revenue per equivalent admission. Same-facility emergency department visits rose 5.1%, while inpatient and outpatient surgical volumes fell 1.4% and 3.7%, respectively.

Net income attributable to HCA fell to $1.579 billion from $1.643 billion a year earlier, according to the filing, although diluted earnings per share rose to $7.27 from $6.96. The filing shows fewer shares were used in the diluted per-share calculation after repurchases.

HCA reported that salaries and benefits fell to 43.2% of revenue from 43.6% a year earlier, while supplies fell to 14.2% from 14.5%. Cash flow from operations rose to $4.461 billion from $4.416 billion.

Adjusted EPS is the figure the consensus estimates, not the GAAP EPS above.

What management said on the call

CEO Sam Hazen said demand grew in the third quarter, with same-facility adjusted admissions up 3% from a year earlier. He said insured volumes grew faster than in the first half, and insured revenue per adjusted admission, excluding supplemental payments, increased at a higher rate. Hazen said the pricing increase partly offset pressure as patients who had exchange coverage became uninsured.

CFO Mike Marks said exchange equivalent admissions fell approximately 19% year over year, although exchange volume improved approximately 8% from the second quarter. Marks said patients losing exchange coverage continued to migrate almost one-for-one to uninsured status, accounting for approximately 80% of uninsured volume growth. HCA estimated that this shift reduced third-quarter adjusted EBITDA by approximately $400 million.

Marks said same-facility cost per equivalent admission, excluding Medicaid supplemental payments, was essentially flat from a year earlier. He also reported approximately $1.36 billion in quarterly capital expenditure and approximately $3 billion in share repurchases.

Asked about the drivers of volume growth, Hazen pointed to population growth, aging, chronic conditions and new technology, as well as HCA’s network investments and patient-flow initiatives. He said the ambulatory platform had grown to almost 3,000 units and that HCA was gaining market share incrementally across many markets. Hazen said: “each market’s slightly different.”

On surgery, Marks said changes to the inpatient-only list were a principal driver of pressure on elective volumes and that the outpatient surgery market had more competitors. For the fourth quarter, he said HCA expected normal seasonal movement but had not assumed an additional pickup in elective demand.

Asked about federal policy changes, Marks said work requirements could have a modest impact in 2027, though HCA was not ready to quantify the earnings effect. He said fourth-quarter results and exchange enrollment would inform the company’s January outlook.

Guidance

HCA reaffirmed its 2026 guidance ranges, but Marks said the company now expects results in the upper half of those ranges. He raised the expected full-year incremental net benefit from Medicaid supplemental payments to $600 million–$800 million and said the unfavorable adjusted EBITDA impact from payer-mix shifts would be at or slightly above the upper end of the prior estimate.

For 2027, Hazen offered preliminary expectations for 2-3% volume growth and earnings generally consistent with 2026. He expects approximately $550 million to $650 million less in Medicaid supplemental-payment net benefits, and said full-year guidance would follow in January.