HCA Healthcare, Inc.
HCA · NYSE
Next quarter
Expected to report Jan 26, 2027 — estimated from last year’s reporting date.
Consensus is $8.15 EPS for Dec 2026 across 9 estimates, ranging $7.76 to $8.51.
HCA Sep 2026
- 7.12%
- $6.74
- $7.22
- —
- $19.85B
Reported results
- $19.85B
- $1.58B
- $7.27
Highlights
- Adjusted EPS beat: Q3 adjusted diluted EPS was $7.22, 7.1% above the $6.74 consensus; GAAP diluted EPS was $7.27.
- Revenue grew, earnings diverged: Revenue rose 3.6% year over year to $19.849 billion, while net income attributable to HCA fell 3.9% to $1.579 billion. Adjusted EBITDA increased 1.2% to $3.918 billion, with margin down to 19.7% from 20.2%.
- Uninsured mix was the central headwind: Management estimated the shift from exchange coverage to uninsured patients cost approximately $400 million in the quarter; uninsured patients were 10.5% of equivalent admissions versus 8.5% a year ago.
- Volumes advanced: Same-facility equivalent admissions grew 3.0%, accelerating from 2.3% year to date; emergency-room visits rose 5.1%, while inpatient and outpatient surgeries declined 1.4% and 3.7%.
- 2026 outlook moved to the upper half: HCA reaffirmed its guidance ranges and said it expects results in their upper half: adjusted EBITDA of $15.4–$16.1 billion and diluted EPS of $28.70–$30.50.
- 2027 starts with offsetting forces: Management preliminarily expects earnings generally consistent with 2026, with 2%–3% volume growth offset by $550–$650 million less in Medicaid supplemental-payment net benefits.
- Cash supported shareholder returns: Operating cash flow was $4.461 billion; HCA repurchased 7.23 million shares for $2.970 billion and declared a quarterly dividend of $0.78 per share.
Analysis
HCA’s third quarter combined a solid demand and adjusted-EPS performance with a pronounced payer-mix drag. Adjusted diluted EPS of $7.22 beat the $6.74 consensus by 7.1% and rose 3.7% year over year; GAAP EPS was $7.27 versus $6.96. Revenue increased 3.6% to $19.849 billion, but attributable net income declined 3.9% to $1.579 billion. Adjusted EBITDA grew just 1.2% to $3.918 billion and its margin contracted 50 basis points to 19.7%. The lower diluted share count, 217.2 million versus 236.2 million a year ago, helped EPS outpace net income. The supplied reported-quarter history stops at Q1 FY2026, so it does not provide a Q2 comparator for a true sequential assessment.
Same-facility equivalent admissions grew 3.0%, but exchange equivalent admissions fell about 19% year over year as patients losing coverage shifted largely to uninsured status. Management put the quarter’s resulting payer-mix hit at approximately $400 million; stronger insured pricing, cost control and supplemental Medicaid payments partly offset it. HCA now expects 2026 results in the upper half of its existing guidance ranges. Looking ahead, management’s preliminary view is for 2027 earnings generally in line with 2026: projected 2%–3% volume growth and ongoing cost initiatives would have to absorb $550–$650 million less in Medicaid supplemental-payment net benefits. These early comments are not formal 2027 guidance.
Earnings and margins
Revenue growth did not translate into higher attributable net income: revenue rose to $19.849 billion from $19.161 billion, while net income attributable to HCA declined to $1.579 billion from $1.643 billion. Adjusted EBITDA increased to $3.918 billion from $3.870 billion, but margin fell to 19.7% from 20.2%. Adjusted EPS rose 3.7% year over year to $7.22, while GAAP EPS of $7.27 included a $0.05-per-share gain on facility sales; the prior-year quarter had a $2 million facility-sale loss. The diluted share count declined to 217.2 million from 236.2 million, supporting per-share growth despite lower net income.
Payer mix pressure
The quarter’s defining offset to volume growth was the movement of patients losing exchange coverage into the uninsured category. Exchange equivalent admissions declined approximately 19% year over year, while uninsured patients reached 10.5% of total equivalent admissions, up from 8.5%. Management estimated the resulting payer-mix shift at approximately $400 million; the release describes the impact as on income before taxes, while the call characterizes it as an adjusted EBITDA impact. HCA said about 80% of uninsured-volume growth reflected patients migrating from exchange coverage, with most of the remainder tied to lower Medicaid conversion, primarily in Texas. Insured equivalent admissions excluding exchanges grew about 3%, and insured revenue per equivalent admission improved, partly cushioning the mix effect.
Volumes and cost control
- Demand: Same-facility admissions rose 2.7% and equivalent admissions 3.0%; emergency-room visits increased 5.1%. Management said equivalent-admission growth accelerated from 2.3% year to date and marked the company’s 22nd consecutive quarter of volume growth.
- Service mix: Same-facility inpatient surgeries declined 1.4% and outpatient surgeries 3.7%. Management described emergent surgery as solid but elective procedures as pressured, while pointing to strength in areas including cardiac, neonatal and trauma services.
- Pricing and costs: Same-facility revenue per equivalent admission increased 0.6%. Excluding Medicaid supplemental-payment programs, cost per equivalent admission was essentially flat year over year and improved 40 basis points sequentially, according to management. Professional fees remained a pressure point, up about 12% year over year.
Guidance and 2027
HCA retained its 2026 guidance ranges and said it now expects results in the upper half. The ranges are $77.0–$79.5 billion in revenue, $6.3–$6.7 billion in attributable net income, $15.4–$16.1 billion in adjusted EBITDA and $28.70–$30.50 in diluted EPS. The company raised its estimate for 2026 incremental net benefits from Medicaid supplemental-payment programs to $600–$800 million. For 2027, management’s preliminary outlook is for earnings generally consistent with 2026, assuming 2%–3% volume growth and favorable cost performance. It expects $550–$650 million less in supplemental-payment net benefits, largely because some 2026 payments relate to prior years. Management said exchange-related payer mix remains a key uncertainty and plans to provide formal 2027 guidance after the fourth quarter.
Cash and capital returns
- Cash generation: Operating cash flow was $4.461 billion, compared with $4.416 billion a year earlier; capital expenditures excluding acquisitions were $1.357 billion.
- Repurchases and dividend: HCA bought back 7.230 million shares for $2.970 billion during the quarter, leaving $4.240 billion under its authorization. The board declared a $0.78-per-share quarterly dividend, payable December 29, 2026.
- Balance sheet: At September 30, cash was $908 million and total debt was $50.493 billion. Management said leverage remained in the lower half of its target range.
