HCA Healthcare (HCA) Q1 2026 earnings summary

Executive summary

• Revenues grew 4.3% year-over-year to $19.109 billion in Q1 2026, with adjusted EBITDA up 1.9% and adjusted diluted EPS up 10.9%.

• Net income attributable to shareholders was $1.62 billion ($7.15 per diluted share), up 0.6% from Q1 2025.

• Respiratory-related admissions and ER visits declined sharply (42% and 32% respectively) due to a mild season and winter storm, but Medicaid supplemental payment recognition offset impacts.

• State supplemental payment programs provided a greater net benefit than anticipated, offsetting volume shortfalls.

• Digital transformation and AI initiatives advanced, supporting quality, safety, and operational efficiency.

Financial highlights

• Same-facility admissions increased 0.9% and equivalent admissions rose 1.3% year-over-year.

• Salaries and benefits were 43.3% of revenues, supply costs 14.9%, and other operating expenses 21.9%.

• Adjusted EBITDA margin was 19.9%, down from 20.4% a year ago; net income margin was 8.5%.

• Cash flow from operations was $2.014 billion, up 22% year-over-year.

• Interest expense increased to $584 million, reflecting a higher average debt balance of $47.225 billion.

Outlook and guidance

• 2026 guidance reaffirmed: revenues expected between $76.5–$80 billion, net income $6.495–$7.035 billion, and adjusted EBITDA $15.55–$16.45 billion.

• Full-year volume growth expected at 2%-3% for the remainder of 2026.

• Supplemental payment program net benefit guidance updated to a decline of $50 million-$250 million versus prior year, not including potential new approvals.

• Exchange-related adjusted EBITDA impact expected to be $600 million-$900 million for the year.

• Planned capital expenditures for 2026 are $5.0–$5.5 billion, with $8.8 billion in projects under construction over the next five years.