HCA Healthcare (HCA) Q1 2026 earnings summary

Executive summary

• Revenue grew 4.3% year-over-year in Q1 2026 to $19.109 billion, with adjusted EBITDA up 1.9% to $3.802 billion and adjusted EPS up 11% to $7.15.

• Net income increased 0.6% to $1.62 billion, and cash flows from operations rose 22% to $2.014 billion.

• Respiratory-related admissions and ER visits declined sharply due to a mild season, impacting volumes, but higher-than-expected state supplemental payments offset much of the impact.

• Winter storms further reduced volumes, but resiliency initiatives and digital transformation, including AI, supported cost control.

• Payer mix shifts from health insurance exchanges were in line with expectations, with ongoing monitoring.

Financial highlights

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

• Inpatient surgeries fell 0.3%, outpatient surgeries declined 1.7%, and ER visits rose 0.3%.

• Adjusted EBITDA margin decreased by 50 basis points to 19.9%; salaries and supplies as a percentage of revenue improved, but other operating expenses rose due to supplemental payments and tech investments.

• Net income margin was 8.5%, down from 8.8% in Q1 2025.

• Cash and cash equivalents stood at $940 million, with total debt at $48.023 billion and total assets at $61.45 billion.

Outlook and guidance

• Full-year 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.

• Volume growth expected at 2%-3% for the remainder of the year.

• Supplemental payment program net benefit guidance updated to a decline of $50M-$250M versus prior year.

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

• Resiliency program targeted to deliver $400M in cost savings for 2026.