Key Highlights

  • HCA Healthcare reported third-quarter adjusted EPS of $7.22, up 3.7% from $6.96, on revenue of $19.849 billion, up 3.6%.
  • Same facility equivalent admissions rose 3.0%, while same facility revenue per equivalent admission rose 0.6% to $18,614.
  • Adjusted EBITDA was $3.918 billion, up 1.2%, with the margin at 19.7% versus 20.2% a year earlier.
  • The company repurchased 7.230 million shares for $2.970 billion in the quarter, with $4.240 billion of authorization remaining.
  • Full-year 2026 results are now expected in the upper half of the ranges issued on July 14, including EPS of $28.70 to $30.50.

HCA Healthcare Earnings: Is Guidance Really Moving to the Upper Half?

HCA Healthcare (NYSE:HCA) reported third-quarter results on Tuesday, October 27, and said full-year 2026 operating results are now expected to land in the upper half of the ranges it issued on July 14. The release did not publish new numeric ranges, so this is a signal toward the high end rather than a formal raise. The existing ranges are revenue of $77.0 billion to $79.5 billion, adjusted EBITDA of $15.4 billion to $16.1 billion, net income attributable to the company of $6.3 billion to $6.7 billion and diluted EPS of $28.70 to $30.50.

Third-quarter revenue was $19.849 billion, up 3.6% from $19.161 billion. Diluted EPS was $7.27 on a GAAP basis, up 4.5% from $6.96, and $7.22 as adjusted, up 3.7%, after removing a $0.05 per share gain on sales of facilities. The EPS estimate as screened was $6.63, so the adjusted figure came in 8.95% above it as screened.

HCA Healthcare Margins and Cash: Why Did Profit Lag Revenue Growth?

Adjusted EBITDA rose 1.2% to $3.918 billion from $3.870 billion, while the margin slipped to 19.7% from 20.2%. Net income attributable to the company fell 3.9% to $1.579 billion from $1.643 billion, and income before income taxes was $2.370 billion, down from $2.418 billion.

Management estimated an unfavorable effect of about $400 million on income before income taxes from higher uninsured volume, mainly patients who lost exchange coverage. The chief executive said the company was resilient despite the challenges brought by federal policy changes this year, and that it is positioned to end the year positively.

Operating cash flow was $4.461 billion in the quarter, compared with $4.416 billion, and capital expenditures were $1.357 billion. Nine-month operating cash flow was $8.810 billion, compared with $10.277 billion a year earlier.

The company repurchased 7.230 million shares for $2.970 billion in the quarter, leaving $4.240 billion of authorization. It declared a quarterly dividend of $0.78 per share, payable on December 29 to holders of record on December 15. Cash was $908 million and total debt was $50.493 billion at September 30.

HCA Healthcare Volumes: Which Hospital Metrics Grew and Which Slipped?

Same facility admissions rose 2.7% to 588,020, and same facility equivalent admissions rose 3.0% to 1,056,672. Same facility emergency room visits rose 5.1% to 2,585,811, a faster pace than inpatient volume.

Surgical activity was softer. Same facility inpatient surgery cases fell 1.4% to 135,620, and outpatient surgery cases fell 3.7% to 237,263. Same facility revenue per equivalent admission rose 0.6% to $18,614.

HCA Healthcare Outlook: What Should Investors Watch Next?

Key markers are whether uninsured volume keeps weighing on margins, whether surgical volumes recover from the third-quarter decline, and how far results move within the 2026 ranges. The pace of buybacks against $4.240 billion of remaining authorization is the other capital item to follow into the fourth-quarter report.