AdaptHealth (AHCO) Q4 2024 earnings summary

Executive summary

• Q4 2024 net revenue was $856.6 million, nearly flat year-over-year, and full year 2024 net revenue grew 1.9% to $3.26 billion, overcoming asset divestitures and reimbursement changes.

• Net income for Q4 2024 was $50.3 million, reversing a $254.5 million loss in Q4 2023; full year net income was $90.4 million versus a $678.9 million loss in 2023.

• Adjusted EBITDA for Q4 2024 was $200.6 million (23.4% margin), and for the full year was $688.7 million (21.1% margin), both up year-over-year.

• Strategic focus included operational excellence, AI/automation, clinical relevance, organic growth, and balance sheet strength.

• Leadership changes, organizational restructuring, and asset sales were implemented to drive accountability and segment performance.

Financial highlights

• Q4 2024 revenue was $856.6 million, flat year-over-year but 3% above guidance midpoint; Sleep and Respiratory Health grew, offsetting Diabetes Health contraction.

• Q4 Adjusted EBITDA margin was 23.4%, slightly down from 23.8% in Q4 2023; full year margin was 21.1%.

• Q4 free cash flow was $73.1 million, up from $66.6 million in Q4 2023; full year free cash flow was $235.8 million, up from $143.2 million in 2023.

• Full-year operating income was $263.7 million, up from a loss of $598.4 million in 2023.

• Goodwill impairment charges were $13.1 million in 2024, significantly lower than $830.8 million in 2023.

Outlook and guidance

• 2025 revenue guidance: $3.22–$3.36 billion, reflecting asset dispositions and revenue mix changes.

• 2025 Adjusted EBITDA expected at $670–$710 million (~21% margin), in line with 2024.

• 2025 free cash flow guidance: $180–$220 million, with one-third expected in H1.

• Guidance excludes impact from future acquisitions or dispositions not yet closed.

• Q1 2025 revenue expected down 3–4% year-over-year; Adjusted EBITDA margin 16–17%.