HCA Healthcare Reports Fourth Quarter 2025 Results and Provides 2026 Guidance

HCA Healthcare, Inc. (NYSE:HCA) today announced financial and operating results for the fourth quarter ended December 31, 2025.

Key fourth quarter metrics (all percentage changes compare 4Q 2025 to 4Q 2024 unless otherwise noted):

• Revenues increased 6.7 percent to $19.513 billion
• Net income attributable to HCA Healthcare, Inc. increased 30.6 percent to $1.878 billion
• Diluted earnings per share increased 44.6 percent to $8.14 per share, and diluted earnings per share, as adjusted, increased 28.8 percent to $8.01 per share
• Adjusted EBITDA increased 10.8 percent to $4.114 billion
• Cash flows from operating activities totaled $2.359 billion, compared to $2.559 billion in the fourth quarter of 2024
• Same facility admissions increased 2.4 percent and same facility equivalent admissions increased 2.5 percent

"We finished 2025 with strong performance consistent with previous quarters. Our investments in network expansion, workforce development, and advancing clinical capabilities further strengthened the HCA Healthcare system. I want to thank our colleagues for their outstanding work, their dedication to our patients, and their unyielding commitment to our mission," said Sam Hazen, Chief Executive Officer of HCA Healthcare.

Revenues in the fourth quarter of 2025 totaled $19.513 billion, compared to $18.285 billion in the fourth quarter of 2024. Net income attributable to HCA Healthcare, Inc. totaled $1.878 billion, or $8.14 per diluted share, compared to $1.438 billion, or $5.63 per diluted share, in the fourth quarter of 2024. Results for the fourth quarter of 2025 include gains on sales of facilities of $41 million, or $0.13 per diluted share, primarily related to the sale of a hospital facility in Indiana. Results for the fourth quarter of 2024 included losses on sales of facilities of $195 million, or $0.59 per diluted share, primarily related to the pending sale of a hospital facility in California, which was completed in the second quarter of 2025.

For the fourth quarter of 2025, Adjusted EBITDA totaled $4.114 billion, compared to $3.712 billion in the fourth quarter of 2024. Adjusted EBITDA is a non-GAAP financial measure. A table providing supplemental information on Adjusted EBITDA and reconciling net income attributable to HCA Healthcare, Inc. to Adjusted EBITDA is included in this release.

During the fourth quarter of 2024, the Company incurred additional expenses and experienced loss of revenues estimated at $200 million, or $0.60 per diluted share, associated with Hurricane Helene's impact on its North Carolina facilities, as well as from Hurricane Milton, which impacted certain facilities in Florida.

Same facility admissions increased 2.4 percent and same facility equivalent admissions increased 2.5 percent in the fourth quarter of 2025 compared to the prior year period. Same facility emergency room visits increased 0.5 percent in the fourth quarter of 2025 compared to the prior year period. Same facility inpatient surgeries were flat, and same facility outpatient surgeries declined 0.5 percent in the fourth quarter of 2025 compared to the same period of 2024. Same facility revenue per equivalent admission increased 2.9 percent in the fourth quarter of 2025 compared to the fourth quarter of 2024.

Year Ended December 31, 2025

Revenues for the year ended December 31, 2025 totaled $75.600 billion compared to $70.603 billion for the year ended December 31, 2024. Net income attributable to HCA Healthcare, Inc. was $6.784 billion, or $28.33 per diluted share, compared to $5.760 billion, or $22.00 per diluted share, for the year ended December 31, 2024. Results for the year ended December 31, 2025 include gains on sales of facilities of $37 million, or $0.12 per diluted share. Results for the year ended December 31, 2024 included gains on sales of facilities of $14 million, or $0.04 per diluted share.

For 2025, Adjusted EBITDA totaled $15.566 billion, compared to $13.882 billion in 2024. Adjusted EBITDA is a non-GAAP financial measure. A table providing supplemental information on Adjusted EBITDA and reconciling net income attributable to HCA Healthcare, Inc. to Adjusted EBITDA is included in this release.

Balance Sheet and Cash Flows from Operations

As of December 31, 2025, HCA Healthcare, Inc.'s balance sheet reflected cash and cash equivalents of $1.040 billion, total debt of $46.492 billion, and total assets of $60.720 billion. During the fourth quarter of 2025, capital expenditures totaled $1.489 billion, excluding acquisitions. Cash flows provided by operating activities in the fourth quarter of 2025 totaled $2.359 billion compared to $2.559 billion in the fourth quarter of 2024, and were impacted by approximately $1.3 billion of estimated tax payments that were deferred to the fourth quarter of 2025 due to IRS relief to taxpayers located in Tennessee as a result of severe weather in April 2025.

During the fourth quarter of 2025, the Company repurchased 5.432 million shares of its common stock at a cost of $2.558 billion. The Company had $750 million remaining under its repurchase authorization as of December 31, 2025. As of December 31, 2025, the Company had $5.779 billion of availability under its credit facilities (after giving effect to letters of credit and amounts reserved to backstop its commercial paper program).

Share Repurchase Program

The HCA Healthcare, Inc. Board of Directors has authorized an additional share repurchase program for up to $10 billion of the Company's outstanding common stock. Repurchases will be made in accordance with applicable securities laws and may be made at management's discretion from time to time in the open market, through privately negotiated transactions, or otherwise. The repurchase program has no time limit and may be suspended for periods or discontinued at any time.

Dividend

HCA today announced that its Board of Directors declared a quarterly cash dividend of $0.78 per share on the Company's common stock. The dividend will be paid on March 31, 2026 to stockholders of record at the close of business on March 17, 2026.

The declaration and payment of any future dividend will be subject to the discretion of the Board of Directors and will depend on a variety of factors, including the Company's financial condition and results of operations. Future dividends are expected to be funded by cash balances and future cash flows from operations.

2026 Guidance

Today, the Company issued the following estimated guidance for 2026:

Capital expenditures for 2026, excluding acquisitions, are estimated to range between $5.0 billion and $5.5 billion.

The Company's guidance contains a number of assumptions, including, among others, the Company's current expectations regarding volume growth coupled with an anticipated mostly stable operating environment, payer mix, the impact of current and future health care public policy developments, including the estimated impact on health insurance exchanges from administrative reforms and the expiration of the enhanced premium tax credits, anticipated results from resiliency initiatives, as well as general business or economic conditions, including inflation and the impact of trade policies, including tariffs, and excludes the impact of items such as, but not limited to, gains or losses on sales of facilities, losses on retirement of debt, legal claims costs and impairment of long-lived assets. In addition, the Company's guidance excludes the impact of future approvals that could impact reimbursement under certain state Medicaid directed and supplemental payments.

Adjusted EBITDA is a non-GAAP financial measure. A table reconciling forecasted net income attributable to HCA Healthcare, Inc. to forecasted Adjusted EBITDA is included in this release.

The Company's guidance is based on current plans and expectations and is subject to a number of known and unknown uncertainties and risks, including those set forth below in the Company's "Forward-Looking Statements."

Annual Stockholders' Meeting

The Company's 2026 annual stockholders' meeting will be held virtually on April 23, 2026 at 2:00 p.m. Central Time for stockholders of record as of February 23, 2026.

Earnings Conference Call

HCA Healthcare will host a conference call for investors at 9:00 a.m. Central Time today. All interested investors are invited to access a live audio broadcast of the call via webcast. The broadcast also will be available on a replay basis beginning this afternoon. The webcast can be accessed through the Company's Investor Relations web page at https://investor.hcahealthcare.com/events-and-presentations/default.aspx.

About the Company

As of December 31, 2025, HCA operated 190 hospitals and approximately 2,500 ambulatory sites of care, including surgery centers, freestanding emergency rooms, urgent care centers and physician clinics, in 19 states and the United Kingdom.

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of the federal securities laws, which involve risks and uncertainties. Forward-looking statements include the Company's financial guidance for the year ending December 31, 2026, as well as other statements that do not relate solely to historical or current facts. Forward-looking statements can be identified by the use of words like "may," "believe," "will," "expect," "project," "estimate," "anticipate," "plan," "initiative" or "continue." These forward-looking statements are based on our current plans and expectations and are subject to a number of known and unknown uncertainties and risks, many of which are beyond our control, which could significantly affect current plans and expectations and our future financial position and results of operations. These factors include, but are not limited to, (1) changes in or related to general economic or business conditions nationally and regionally in our markets, including inflation, and the impact of trade policies, including changes in, or the imposition of, tariffs and/or trade barriers; changes in revenues resulting from declining patient volumes; changes in payer mix (including increases in uninsured and underinsured patients); potential increased expenses related to labor, pharmaceuticals, supply chain or other expenditures; workforce disruptions; supply and pharmaceutical shortages and disruptions (including as a result of tariffs or geopolitical disruptions); and the impact of federal government shutdowns, holds on or cancellations of congressionally authorized spending and interruptions in the distribution of governmental funds, (2) the impact of current and future health care public policy developments and the implementation of new, and possible changes to existing, federal, state or local laws and regulations affecting the health care industry, including the expiration at the end of 2025 of enhanced premium tax credits ("EPTCs") for eligible individuals purchasing insurance coverage through federal and state-based health insurance marketplaces, changes in the structure and administration of, and funding for, federal and state agencies and programs, and effects of the One Big Beautiful Bill Act (the "OBBBA"), (3) the impact of our significant indebtedness and the ability to refinance such indebtedness on acceptable terms, (4) the effects related to the implementation of sequestration spending reductions required under the Budget Control Act of 2011, related legislation extending these reductions, and the potential for future deficit or other spending reduction legislation that may alter current spending reductions, which include cuts to Medicare payments, or impose additional spending reductions, (5) the ability to achieve operating and financial targets, develop and execute resiliency plans to offset to the extent possible impacts from the OBBBA, the expiration of EPTCs and tariffs, attain expected levels of patient volumes and revenues, and control the costs of providing services, (6) possible reductions or other changes in Medicare, Medicaid and other state programs, including Medicaid supplemental payment programs, Medicaid waiver programs and state directed payment arrangements, any of which may negatively impact reimbursements to health care providers and insurers and the size of the uninsured or underinsured population, (7) the results of our efforts to use technology and resilience initiatives, including artificial intelligence and machine learning, to drive efficiencies, better outcomes and an enhanced patient experience, (8) increases in the amount and risk of collectability of uninsured accounts and deductibles and copayment amounts for insured accounts, (9) personnel-related capacity constraints, increases in wages and the ability to attract, utilize and retain qualified management and other personnel, including affiliated physicians, nurses and medical and technical support personnel, (10) the highly competitive nature of the health care business, (11) changes in service mix, revenue mix and service volumes, including potential declines in the population covered under third-party payer agreements, the ability to enter into and renew third-party payer provider agreements on acceptable terms and the impact of consumer-driven health plans and physician utilization trends and practices, (12) the efforts of health insurers, health care providers, large employer groups and others to contain health care costs, (13) the outcome of our continuing efforts to monitor, maintain and comply with appropriate laws, regulations, policies and procedures, (14) the availability and terms of capital to fund the expansion of our business and improvements to our existing facilities, (15) changes in accounting practices, (16) the emergence of and effects related to pandemics, epidemics and outbreaks of infectious diseases or other public health crises, (17) future divestitures which may result in charges and possible impairments of long-lived assets, (18) changes in business strategy or development plans, (19) delays in receiving payments for services provided, (20) the outcome of pending and any future tax audits, disputes and litigation associated with our tax positions, (21) the impact of known and unknown government investigations, litigation and other claims that may be made against us, (22) the impact of actual and potential cybersecurity incidents or security breaches involving us or our vendors and other third parties, (23) our ongoing ability to demonstrate meaningful use of certified electronic health record technology and the impact of interoperability requirements, (24) the impact of natural disasters, such as hurricanes and floods, including Hurricanes Milton and Helene, physical risks from changing global weather patterns or similar events beyond our control on our assets and activities and the communities we serve, (25) changes in U.S. federal, state, or foreign tax laws, interpretations of tax laws by taxing authorities, other standard setting bodies or judicial decisions, (26) changes to, and the timing and amount of future approvals (if any) of, state Medicaid directed and supplemental payments and (27) other risk factors described in our annual report on Form 10-K for the year ended December 31, 2024 and our other filings with the Securities and Exchange Commission. Many of the factors that will determine our future results are beyond our ability to control or predict. In light of the significant uncertainties inherent in the forward-looking statements contained herein, readers should not place undue reliance on forward-looking statements, which reflect management's views only as of the date hereof. We undertake no obligation to revise or update any forward-looking statements, or to make any other forward-looking statements, whether as a result of new information, future events or otherwise. All references to "Company," "HCA" and "HCA Healthcare" as used throughout this release refer to HCA Healthcare, Inc. and its affiliates.

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INVESTOR CONTACT:

Frank Morgan

615-344-2688 

MEDIA CONTACT:

Harlow Sumerford

615-344-1851