Astrana Health (ASTH) Q3 2026 earnings summary

Executive summary

• Record Q3 revenue of $1,023.6M rose 7% YoY; adjusted EBITDA reached $77.2M, up 13%, and adjusted diluted EPS was $0.71.

• GAAP net income was $20.3M versus $1.1M; net income attributable to Astrana was $13.0M versus $0.4M.

• 9M revenue was $2,961.2M, up 33%; adjusted EBITDA was $212.4M, up 39%, and adjusted diluted EPS was $2.25, up 36%.

• Strategic focus includes an AI-native, physician-centric platform, integrated care, patient outcomes, and total cost of care.

Financial highlights

• Total revenue was $1,023.6M versus $956.0M; capitation revenue was $936.7M versus $863.4M.

• Operating income was $39.9M versus $19.2M; EBITDA was $58.7M versus $35.5M, and adjusted EBITDA margin was 8% versus 7%.

• Q3 adjusted EBITDA was at the high end of the $72.5M–$77.5M guidance range; $5M–$10M of MA risk-adjustment sweep revenue and 2026 MSSP shared-savings accruals are not expected to recur in Q4.

• 9M operating cash flow was $117.1M and free cash flow was $105.4M, versus $104.5M of free cash flow a year earlier.

Outlook and guidance

• FY26 guidance was narrowed with midpoints maintained: revenue $3.9B–$4.0B, adjusted EBITDA $261M–$274M, and free cash flow $107.5M–$130M.

• Guidance midpoint growth versus FY25 is 24.1% for revenue, 30.2% for adjusted EBITDA, and 13.6% for free cash flow.

• Q4 guidance is revenue of $939M–$1,039M and adjusted EBITDA of $48.5M–$61.5M; Q4 is expected to be the year's lowest-profitability quarter.

• Medium-term adjusted EBITDA growth ambition is at least mid-teens, supported by cohort maturation, risk conversions, new MA partnerships, and operating leverage; formal FY27 guidance is expected with Q4 results.

• FY27 planning assumes 10%–15% Medicaid membership decline; FY26 outlook assumes conservative Medicaid trends and excludes HQAF 10 contribution.