HCA Healthcare Expects 2026 Results in Upper Half of Existing Guidance

The Tip Desk · October 30, 2026 · 4 min read

The hospital operator reported third-quarter 2026 revenue of $19.849 billion, up 3.6 percent, and said an uninsured payer-mix shift cut pre-tax income by about $400 million, matching its second-quarter estimate.

HCA Healthcare, Inc. (HCA) reported third-quarter 2026 revenue of $19.849 billion, up 3.6 percent, and said an uninsured payer-mix shift cut pre-tax income by about $400 million in the third quarter, matching its second-quarter estimate, and that full-year 2026 operating results will sit in the upper half of the ranges it issued on July 14.

The hospital operator, which ran 189 hospitals and about 2,600 ambulatory sites as of September 30, 2026, attributed the mix shift to an increase in uninsured volume, primarily patients who lost coverage on the health insurance exchanges. The company said the shift had an unfavorable impact on income before income taxes of approximately $400 million during the third quarter. That estimate matched the second-quarter figure.

Revenues increased 3.6 percent to $19.849 billion, a slower year-over-year pace than the 8.7 percent increase to $20.230 billion in the second quarter. Net income attributable to HCA Healthcare, Inc. declined 3.9 percent to $1.579 billion, or $7.27 a share, reversing a 2.8 percent increase to $1.699 billion in the prior quarter. Diluted earnings per share, as adjusted, increased 3.7 percent to $7.22. Adjusted EBITDA increased 1.2 percent to $3.918 billion, slower than the 4.6 percent increase to $4.027 billion in the second quarter. Adjusted EBITDA margin compressed to 19.7 percent from 20.2 percent a year earlier.

Results included gains on sales of facilities of $13 million, or $0.05 a share, compared with losses of $2 million in the third quarter of 2025. Cash flows from operating activities totaled $4.461 billion, compared with $4.416 billion a year earlier.

Same facility admissions increased 2.7 percent and same facility equivalent admissions increased 3.0 percent, accelerating from 2.5 percent and 2.7 percent in the second quarter. Same facility emergency room visits increased 5.1 percent, faster than the 3.6 percent increase in the prior quarter. Same facility inpatient surgeries declined 1.4 percent and same facility outpatient surgeries declined 3.7 percent. Same facility revenue per equivalent admission increased 0.6 percent.

The company said that despite the unfavorable payer mix, third-quarter results reflected improvement in key areas: growth accelerated in same facility equivalent admissions and insured revenue per equivalent admission excluding Medicaid Supplemental Payment Programs, cost results improved, and the net benefit from those programs modestly increased. In the second quarter, HCA had recognized about $400 million of incremental net benefit from Medicaid Supplemental Payment Programs, primarily related to Florida, for the period October 1, 2024 through June 30, 2026.

Chief Executive Officer Sam Hazen said that despite challenges from federal policy changes this year, colleagues continued to provide high-quality care and that HCA Healthcare is positioned to end the year positively.

The company now believes full-year 2026 operating results will be in the upper half of its July 14 guidance ranges: revenues of $77.000 billion to $79.500 billion, net income attributable to HCA Healthcare, Inc. of $6.300 billion to $6.700 billion, and Adjusted EBITDA of $15.400 billion to $16.100 billion. Guidance assumptions include volume growth, an anticipated mostly stable operating environment, payer mix, service mix, the impact of health-care public policy including estimated effects of administrative reforms and the expiration of enhanced premium tax credits on health insurance exchanges, anticipated results from resiliency initiatives, and general economic conditions including inflation and trade policies. The ranges exclude gains or losses on sales of facilities, losses on retirement of debt, legal claims costs and impairment of long-lived assets, and exclude future approvals that could affect reimbursement under certain state Medicaid directed and supplemental payments.

During the third quarter the company repurchased 7.230 million shares at a cost of $2.970 billion, leaving $4.240 billion remaining under its repurchase authorization as of September 30, 2026. Cash and cash equivalents were $908 million, total debt was $50.493 billion, and capital expenditures excluding acquisitions totaled $1.357 billion. The board declared a quarterly cash dividend of $0.78 a share, payable December 29, 2026.