Key Highlights

  • Revenue rose 3.6% to USD 19.849 billion, while net income fell 3.9% to USD 1.579 billion.
  • Diluted EPS rose 4.5% to USD 7.27, and adjusted diluted EPS rose 3.7% to USD 7.22.
  • A payer mix shift toward uninsured patients who lost exchange coverage cut pretax income by about USD 400 million.
  • Management placed full-year 2026 results in the upper half of its guidance ranges and repurchased USD 2.97 billion of stock.

Volumes Grow, Payer Mix Shifts

HCA Healthcare (NYSE:HCA) reported third-quarter revenue of USD 19.849 billion on Tuesday, up 3.6% from USD 19.161 billion. Net income attributable to the company was USD 1.579 billion against USD 1.643 billion, while diluted earnings per share rose to USD 7.27 from USD 6.96. Adjusted diluted EPS was USD 7.22, and adjusted EBITDA rose 1.2% to USD 3.918 billion. Results included USD 13 million of gains on facility sales. Cash flow from operations was USD 4.461 billion.

Same facility admissions rose 2.7% and equivalent admissions rose 3.0%, which management called the 22nd consecutive quarter of volume growth. Emergency room visits rose 5.1%, while inpatient surgeries fell 1.4% and outpatient surgeries fell 3.7%. Revenue per equivalent admission rose 0.6%.

Chief Executive Sam Hazen said the company has staying power from scale and culture despite challenges from federal policy changes this year.

Payer Mix and Costs

The company estimated that a shift in payer mix, driven by uninsured patients who lost coverage on the health insurance exchanges, reduced pretax income by about USD 400 million. Uninsured volume reached 10.5% of equivalent admissions against 8.5% a year earlier. Exchange equivalent admissions fell 19% from a year earlier, though they improved 8% from the second quarter. Ambulatory surgery cases fell 5.4%, mainly on reduced exchange coverage.

Management pointed to improvement elsewhere: equivalent admissions growth accelerated, insured revenue per equivalent admission excluding Medicaid supplemental payments improved, and same facility operating costs per equivalent admission were essentially flat excluding those programs. Professional fees rose 12% on radiology and anesthesiology costs.

The net benefit from Medicaid supplemental payment programs increased by about USD 50 million, and management raised its 2026 estimate for that benefit to USD 600 million to USD 800 million.

Guidance and Capital

Management now believes full-year 2026 results land in the upper half of the ranges issued on July 14, which are USD 77 billion to USD 79.5 billion of revenue and USD 15.4 billion to USD 16.1 billion of adjusted EBITDA. For 2027, management described volume growth of 2% to 3%, in line with long-term targets, and adjusted EBITDA generally consistent with 2026 because of a USD 550 million to USD 650 million reduction in net Medicaid supplemental payment benefits.

Capital expenditures were USD 1.357 billion, directed at hospital expansion and inpatient capacity. The company spent USD 2.970 billion repurchasing 7.230 million shares in the quarter.

Hospital Markers to Follow

Tracking points include uninsured volume against 10.5% of equivalent admissions, exchange equivalent admissions after the 19% decline, and surgical volumes against the 3.7% outpatient decline.

Further items are the Medicaid supplemental benefit against the USD 600 million to USD 800 million estimate, professional fee growth relative to 12%, and adjusted EBITDA against the guidance range.