HCA Healthcare — Third Quarter 2026 Earnings Summary

Financial Performance:

• Revenues increased 3.6% year-over-year to $19.849 billion for the third quarter of 2026, compared to $19.161 billion in the prior year period.
• Net income attributable to HCA Healthcare, Inc. declined 3.9% to $1.579 billion, or $7.27 per diluted share, compared to $1.643 billion, or $6.96 per diluted share, in the third quarter of 2025.
• Adjusted EBITDA increased 1.2% to $3.918 billion, compared to $3.870 billion in the third quarter of 2025, with an adjusted EBITDA margin of 19.7% versus 20.2% in the prior year period.
• Diluted earnings per share, as adjusted, increased 3.7% to $7.22 per share.
• Cash flows from operating activities totaled $4.461 billion for the quarter, compared to $4.416 billion in the third quarter of 2025.
• For the nine months ended September 30, 2026, revenues totaled $59.188 billion, and net income attributable to HCA Healthcare, Inc. was $4.898 billion, or $22.05 per diluted share.
• As of September 30, 2026, total debt stood at $50.493 billion, and cash and cash equivalents were $908 million.
• Capital expenditures for the third quarter totaled $1.357 billion, excluding acquisitions.

Guidance and Future Outlook:

• The Company updated its full-year 2026 guidance, now expecting operating results to fall in the upper half of the previously issued estimated ranges.
• Forecasted full-year 2026 revenues are estimated between $77.0 billion and $79.5 billion.
• Forecasted full-year 2026 net income attributable to HCA Healthcare, Inc. is estimated between $6.3 billion and $6.7 billion.
• Forecasted full-year 2026 Adjusted EBITDA is estimated between $15.4 billion and $16.1 billion.
• Forecasted full-year 2026 diluted earnings per share is estimated between $28.70 and $30.50.
• Guidance assumptions include volume growth, a mostly stable operating environment, payer mix, service mix, and the impact of health care public policy developments, including the expiration of enhanced premium tax credits and administrative reforms.
• Guidance excludes gains or losses on sales of facilities, losses on retirement of debt, legal claims costs, and impairment of long-lived assets.

Business Segments and Product Lines:

• Same facility admissions increased 2.7%, and same facility equivalent admissions increased 3.0% in the third quarter of 2026 compared to the prior year.
• Same facility emergency room visits increased 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 operates 189 hospitals and approximately 2,600 ambulatory sites of care across 19 states and the United Kingdom as of September 30, 2026.

Market and Competitive Landscape:

• The Company experienced a payer mix shift driven by an increase in uninsured volume, primarily due to patients losing coverage on health insurance exchanges.
• This payer mix shift had an unfavorable impact on income before income taxes of approximately $400 million during the third quarter.
• Despite the payer mix shift, the Company reported acceleration in same facility equivalent admissions and insured revenue per equivalent admission (excluding Medicaid Supplemental Payment Programs).
• Cost results improved, and the net benefit from Medicaid Supplemental Payment Programs modestly increased.

Risks and Challenges:

• Significant risks include changes in general economic conditions, inflation, and the impact of trade policies and tariffs.
• Risks related to payer mix, including increases in uninsured and underinsured patients, and potential increased expenses related to labor, pharmaceuticals, and supply chains.
• Potential impacts from federal government shutdowns, holds on spending, and the expiration of enhanced premium tax credits.
• Risks associated with significant indebtedness and the ability to refinance on acceptable terms.
• Potential reductions in Medicare, Medicaid, and other state programs, including Medicaid supplemental payment programs.
• Workforce disruptions, personnel-related capacity constraints, and the ability to attract and retain qualified management and medical personnel.
• Cybersecurity incidents, natural disasters, and changes in U.S. federal, state, or foreign tax laws.

Management Commentary and Tone:

• CEO Sam Hazen stated that HCA has strong staying power due to its scale, critical role in communities, and disciplined culture.
• Management noted that despite challenges from federal policy changes, colleagues continued to provide high-quality care.
• The Company expressed confidence that it is positioned to end the year positively.
• Management highlighted improvements in key business areas despite the unfavorable payer mix shift.

Other Key Points:

• The Board of Directors declared a quarterly cash dividend of $0.78 per share, payable on December 29, 2026, to stockholders of record on December 15, 2026.
• During the third quarter, the Company repurchased 7.230 million shares of common stock at a cost of $2.970 billion.
• As of September 30, 2026, the Company had $4.240 billion remaining under its stock repurchase authorization.
• The Company had $2.226 billion of availability under its credit facility as of September 30, 2026.
• Results for the third quarter of 2026 included gains on sales of facilities of $13 million ($0.05 per diluted share), compared to losses of $2 million in the prior year period.
• Results for the nine months ended September 30, 2026, included gains on sales of facilities of $22 million ($0.08 per diluted share).