Third Quarter 2026
Filed Oct 27, 2026HCA Healthcare reports THIRD quarter 2026 results
Revenue, admissions, equivalent admissions and Adjusted EBITDA increased, while net income attributable to HCA Healthcare, Inc. declined and Adjusted EBITDA margin contracted. The Company cited an unfavorable payer mix shift with an estimated approximately $400 million impact on income before income taxes.
Key metrics
shortened, hover for the filing’s print| Metric | Value | q/q | y/y |
|---|---|---|---|
| Third Quarter RevenuesGAAP | $19.85B | – | 3.6 percent |
| Third Quarter Salaries and benefitsGAAP | 8,581 | – | – |
| Third Quarter SuppliesGAAP | 2,822 | – | – |
| Third Quarter Other operating expensesGAAP | 4,548 | – | – |
| Third Quarter Equity in earnings of affiliatesGAAP | (20 ) | – | – |
| Third Quarter Depreciation and amortizationGAAP | 954 | – | – |
| Third Quarter Interest expenseGAAP | 607 | – | – |
| Third Quarter Losses (gains) on sales of facilitiesGAAP | (13 ) | – | – |
| Third Quarter Income before income taxesGAAP | 2,370 | – | – |
| Third Quarter Provision for income taxesGAAP | 521 | – | – |
| Third Quarter Net incomeGAAP | 1,849 | – | – |
| Third Quarter Net income attributable to noncontrolling interestsGAAP | 270 | – | – |
| Third Quarter Net income attributable to HCA Healthcare, Inc.GAAP | $1.58B | – | declined 3.9 percent |
| Third Quarter Diluted earnings per shareGAAP | $ 7.27 | – | increased 4.5 percent |
| Third Quarter Shares used in computing diluted earnings per share (millions)GAAP | 217.2M | – | – |
| Third Quarter Comprehensive income attributable to HCA Healthcare, Inc.GAAP | $1.56B | – | – |
| Third Quarter Net income attributable to HCA Healthcare, Inc., as adjustednon-GAAP | 1,569 | – | – |
| Third Quarter Adjusted EBITDAnon-GAAP | $3.92B | – | increased 1.2 percent |
| Third Quarter Adjusted EBITDA marginnon-GAAP | 19.7 % | – | – |
| Third Quarter Diluted earnings per share, as adjustednon-GAAP | $ 7.22 | – | increased 3.7 percent |
| Nine Months RevenuesGAAP | $59.19B | – | – |
| Nine Months Net income attributable to HCA Healthcare, Inc.GAAP | $4.90B | – | – |
| Nine Months Diluted earnings per shareGAAP | $ 22.05 | – | – |
| Nine Months Adjusted EBITDAnon-GAAP | $11.75B | – | – |
| Nine Months Adjusted EBITDA marginnon-GAAP | 19.8 % | – | – |
| Nine Months Diluted earnings per share, as adjustednon-GAAP | $ 21.97 | – | – |
| Third Quarter Cash flows from operating activitiesGAAP | $4.46B | – | – |
| Nine Months Net cash provided by operating activitiesGAAP | 8,810 | – | – |
| Nine Months Purchase of property and equipmentGAAP | (3,707 ) | – | – |
| Nine Months Acquisition of hospitals and health care entitiesGAAP | (942 ) | – | – |
| Nine Months Net cash used in investing activitiesGAAP | (4,755 ) | – | – |
| Nine Months Payment of dividendsGAAP | (519 ) | – | – |
| Nine Months Repurchase of common stockGAAP | (6,605 ) | – | – |
| Nine Months Net cash used in financing activitiesGAAP | (4,183 ) | – | – |
| Cash and cash equivalents at end of periodGAAP | $908M | – | – |
| Total assetsGAAP | $63.45B | – | – |
| Short-term borrowings and long-term debt due within one yearGAAP | 8,093 | – | – |
| Long-term debt, less debt issuance costs and discountsGAAP | 42,400 | – | – |
| Stockholders' deficit attributable to HCA Healthcare, Inc.GAAP | (8,077 ) | – | – |
| Third Quarter Capital expenditures, excluding acquisitionsother | $1.36B | – | – |
| Third Quarter Same facility admissionsother | 588,020 | – | 2.7 % |
| Third Quarter Same facility equivalent admissionsother | 1,056,672 | – | 3.0 % |
| Third Quarter Same facility revenue per equivalent admissionother | $ 18,614 | – | 0.6 % |
| Third Quarter Same facility inpatient surgery casesother | 135,620 | – | -1.4 % |
| Third Quarter Same facility outpatient surgery casesother | 237,263 | – | -3.7 % |
| Third Quarter Same facility emergency room visitsother | 2,585,811 | – | 5.1 % |
| Third Quarter Occupancyother | 73.2 % | – | – |
Amounts quoted below without a unit are in millions, as in the filing’s tables. Per-share figures are as printed.
For the Year Ending December 31, 2026 outlook
- Revenue$ 77,000 to $ 79,500
- NoteNet income attributable to HCA Healthcare, Inc. (a): $ 6,300 to $ 6,700
- NoteDepreciation and amortization: 3,745 to 3,795
- NoteInterest expense: 2,410 to 2,470
- NoteProvision for income taxes: 1,975 to 2,125
- NoteNet income attributable to noncontrolling interests: 970 to 1,010
- NoteAdjusted EBITDA (a) (b): $ 15,400 to $ 16,100
- NoteDiluted earnings per share: $ 28.70 to $ 30.50
- NoteShares used in computing diluted earnings per share (millions): 219.500
Capital returns
- During the third quarter of 2026, the Company repurchased 7.230 million shares of its common stock at a cost of $2.970 billion.
- The Company had $4.240 billion remaining under its repurchase authorization as of September 30, 2026.
- The Board of Directors declared a quarterly cash dividend of $0.78 per share, payable on December 29, 2026 to stockholders of record at the close of business on December 15, 2026.
What drove it
- Same facility admissions increased 2.7 percent and same facility equivalent admissions increased 3.0 percent.
- Same facility emergency room visits increased 5.1 percent.
- The Company said growth accelerated in same facility equivalent admissions and insured revenue per equivalent admission, excluding Medicaid Supplemental Payment Programs.
- The Company said cost results improved and the net benefit from Medicaid Supplemental Payment Programs modestly increased.
Concerns
- The Company experienced a payer mix shift driven by an increase in uninsured volume, primarily due to patients who lost coverage on the health insurance exchanges.
- The Company estimates the payer mix shift had an unfavorable impact on income before income taxes of approximately $400 million during the third quarter.
- Same facility inpatient surgeries declined 1.4 percent and same facility outpatient surgeries declined 3.7 percent.
- Third-quarter Adjusted EBITDA margin was 19.7 %, compared with 20.2 %.
What to watch
- Volume growth and payer mix, including uninsured volume.
- The impact of current and future health care public policy developments, including health insurance exchanges and enhanced premium tax credits.
- The anticipated mostly stable operating environment, service mix, inflation, tariffs and resiliency initiatives.
- Future approvals affecting reimbursement under certain state Medicaid directed and supplemental payments.
Balance sheet and cash flow
- As of September 30, 2026, cash and cash equivalents were $908 million, total debt was $50.493 billion, and total assets were $63.452 billion.
- As of September 30, 2026, the Company had $2.226 billion of availability under its credit facility.
- Nine-month net cash provided by operating activities was 8,810, versus 10,277 in 2025.
- Nine-month net cash used in investing activities was (4,755 ) and net cash used in financing activities was (4,183 ).
Analysis
Third-quarter revenue increased to $19.849 billion as same facility admissions, equivalent admissions and emergency room visits rose. Same facility revenue per equivalent admission also increased, while both inpatient and outpatient surgery cases declined. The Company identified accelerated growth in same facility equivalent admissions and insured revenue per equivalent admission, excluding Medicaid Supplemental Payment Programs, as areas of improvement.
Profit performance was constrained by payer mix. Net income attributable to HCA Healthcare, Inc. declined to $1.579 billion even as diluted earnings per share increased to $7.27 per diluted share and Adjusted EBITDA increased to $3.918 billion. The Company attributed a material unfavorable effect to higher uninsured volume, estimating an approximately $400 million unfavorable impact on income before income taxes during the quarter.
The expense and margin profile deserves attention. Salaries and benefits, supplies, other operating expenses, depreciation and amortization, and interest expense were all higher than in the prior-year quarter. Adjusted EBITDA margin was 19.7 %, below 20.2 % in the prior-year quarter. Management nevertheless stated that cost results improved and that the net benefit from Medicaid Supplemental Payment Programs modestly increased.
Capital deployment remained substantial. The Company repurchased 7.230 million shares for $2.970 billion during the quarter, declared a $0.78 per share quarterly dividend, and reported $4.240 billion remaining under its repurchase authorization. Cash and cash equivalents were $908 million and total debt was $50.493 billion at September 30, 2026.
For the full year, the Company said it now expects operating results in the upper half of the guidance ranges previously issued on July 14, 2026. The published forecast ranges include revenues of $77,000 to $79,500 and Adjusted EBITDA of $15,400 to $16,100. The outlook excludes specified items and remains conditioned on volume, payer mix, public-policy developments, reimbursement approvals, costs and broader operating conditions.
Management, verbatim
I have often mentioned that HCA has strong staying power because of our scale, the important role we play in providing critical services to communities, and our disciplined culture. Despite the challenges brought about by federal policy changes this year, our colleagues have continued to provide high-quality care to patients, and we believe HCA Healthcare is positioned to end the year positively.”
Sam Hazen, Chief Executive Officer of HCA Healthcare
Not in the filing
stated, not guessed- Prior outlook section with the July 14, 2026 guidance ranges was not provided; therefore, comparison of actual results with prior guidance is unavailable.
- Gross margin was not reported.
- Segment revenue was not reported.
- Third-quarter free cash flow was not reported.
- Quarterly cash flow statement line-item detail was not reported.
- Nine-month operating-statistics data beyond the figures separately captured in key metrics is not exhaustively itemized in this response.
Written by an AI language model from the company’s SEC earnings filing (Form 8-K Item 2.02, or Form 6-K for a foreign private issuer). Every figure is checked against the filing text, and a metric the filing does not print, or whose value, prior period and change do not add up, is dropped from the metrics. The model can still misread a table, in the metrics or in the text, so check a number in the filing before you rely on it. Consensus estimates, price targets and share-price reactions are not shown because they are not in the filing. AI-generated research, not investment advice.