HCA Healthcare sees upper half of guidance despite $400 million coverage hit

HCA Healthcare said it expects 2026 results in the upper half of its guidance ranges after a third quarter in which earnings per share rose despite about $400 million of pressure from patients who lost insurance exchange coverage.

The hospital operator reported diluted earnings of $7.27 per share, up 4.5% from $6.96, and adjusted EPS of $7.22, up 3.7%, according to the earnings release attached to its 8-K on Tuesday. Net income fell 3.9% to $1.579 billion, while revenue rose 3.6% to $19.849 billion.

Uninsured volume rises

HCA said it saw a payer mix shift driven by more uninsured patients, "primarily due to patients who lost coverage on the health insurance exchanges." It estimated the shift cut pretax income by about $400 million in the quarter.

CEO Sam Hazen pointed to "challenges brought about by federal policy changes this year" and said the company is positioned to end the year positively.

Same-facility admissions rose 2.7% and equivalent admissions rose 3.0%. Emergency room visits climbed 5.1%, while inpatient surgeries fell 1.4% and outpatient surgeries fell 3.7%. Adjusted EBITDA rose 1.2% to $3.918 billion.

Guidance and capital return

HCA now believes full-year results will land in the upper half of the 2026 guidance ranges it issued on July 14.

During the quarter it repurchased 7.23 million shares for $2.97 billion, leaving $4.24 billion under its authorization. The board declared a quarterly dividend of $0.78 per share, payable Dec. 29 to holders of record on Dec. 15. Operating cash flow was $4.461 billion.

By the numbers

• Q3 revenue: $19.849 billion, up 3.6%
• Diluted EPS: $7.27, up 4.5%
• Estimated exchange-coverage hit: about $400 million pretax
• Buybacks: $2.97 billion
• Quarterly dividend: $0.78

Sources

1. HCA Healthcare, Inc., Form 8-K with third quarter 2026 earnings release, filed Oct. 27, 2026 (accession 0001193125-26-432665)

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