HCA Healthcare third-quarter net income falls 3.9% as revenue rises to $19.849 billion

HCA Healthcare, Inc. (HCA) reported third-quarter 2026 revenue of $19.849 billion, up 3.6% from a year earlier, the company said Tuesday in a regulatory filing. Net income attributable to HCA Healthcare, Inc. fell 3.9%, while diluted earnings per share rose 4.5%.

Here's how the company did:

• Revenue: $19.849 billion vs. $19.161 billion a year earlier
• Diluted earnings per share: $7.27 vs. $6.96 a year earlier
• Net income attributable to HCA Healthcare, Inc.: $1.579 billion vs. $1.643 billion a year earlier
• Adjusted EBITDA: $3.918 billion vs. $3.870 billion a year earlier
• Diluted earnings per share, as adjusted: $7.22 vs. $6.96 a year earlier

The company's adjusted figures exclude losses and gains on sales of facilities and losses on retirement of debt. Adjusted EBITDA, a non-GAAP measure, rose 1.2% to $3.918 billion.

Adjusted EBITDA margin was 19.7%, compared with 20.2% a year earlier.

Patient volumes and payer mix

Same facility admissions increased 2.7% and same facility equivalent admissions increased 3.0%. Same facility emergency room visits rose 5.1%.

Same facility inpatient surgeries declined 1.4%, and same facility outpatient surgeries declined 3.7%. Same facility revenue per equivalent admission increased 0.6%.

The company said it experienced a payer mix shift in the quarter, driven by an increase in uninsured volume, primarily patients who lost coverage on the health insurance exchanges.

The company put the unfavorable impact of that shift on income before income taxes at about $400 million for the third quarter.

The company said parts of the business improved despite the shift. Growth accelerated in same facility equivalent admissions and in insured revenue per equivalent admission, excluding Medicaid Supplemental Payment Programs. Cost results improved, and the net benefit from those programs modestly increased.

"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," CEO Sam Hazen said.

As of Sept. 30, the company operated 189 hospitals, down from 191 a year earlier, and 117 freestanding outpatient surgery centers, down from 123.

2026 guidance

The company now believes its full-year operating results will be in the upper half of its 2026 estimated guidance ranges previously issued on July 14, 2026. The filing does not restate the earlier ranges, so the size of the change is not given.

The updated forecast for the year ending Dec. 31, 2026 is shown below.

The guidance assumes a mostly stable operating environment and excludes items such as gains or losses on sales of facilities, losses on retirement of debt, legal claims costs and impairment of long-lived assets.

Nine-month results

Revenue for the nine months ended Sept. 30 totaled $59.188 billion, compared with $56.087 billion a year earlier. Net income attributable to HCA Healthcare, Inc. was $4.898 billion, or $22.05 per diluted share, compared with $4.906 billion, or $20.23 per diluted share.

Adjusted EBITDA for the nine months was $11.747 billion, compared with $11.452 billion. Results for the period include gains on sales of facilities of $22 million, or $0.08 per diluted share. A year earlier the company reported losses on sales of facilities of $4 million, or $0.01 per diluted share.

Cash flow and share repurchases

Cash flows provided by operating activities in the third quarter totaled $4.461 billion, compared with $4.416 billion a year earlier. For the nine months, operating cash flow was $8.810 billion, compared with $10.277 billion.

During the third quarter the company repurchased 7.230 million shares of its common stock at a cost of $2.970 billion. It had $4.240 billion remaining under its repurchase authorization as of Sept. 30.

As of Sept. 30, the company reported cash and cash equivalents of $908 million and total debt of $50.493 billion. Capital expenditures in the quarter totaled $1.357 billion, excluding acquisitions.

Dividend

The board declared a quarterly cash dividend of $0.78 per share. It is payable Dec. 29 to stockholders of record at the close of business on Dec. 15. The filing does not give the previous quarterly rate.

The company said any future dividends will be subject to the board's discretion and will depend on its financial condition and results of operations, and that they are expected to be funded by cash balances and future cash flows from operations.