HCA Healthcare (HCA) Q4 2025 earnings summary

Executive summary

• Achieved 19th consecutive quarter of volume growth, with record 47 million patient encounters in 2025.

• Fourth quarter 2025 revenues rose 6.7% year-over-year to $19.513 billion, with net income up 30.6% to $1.878 billion and adjusted EBITDA up 10.8% to $4.114 billion.

• Full-year 2025 revenues reached $75.600 billion, net income $6.784 billion, and adjusted EBITDA $15.566 billion, all showing strong year-over-year growth.

• Investments in network expansion, workforce, and clinical capabilities drove positive outcomes.

• Strategic focus on resiliency, competitive positioning, and financial strength to navigate policy changes.

Financial highlights

• Q4 2025 revenue up 6.7% year-over-year; net income up almost 31%; adjusted EBITDA up ~11%.

• Full-year 2025: revenue up 6.6%, equivalent admissions up 2.4%, net revenue per equivalent admission up 4.1%.

• Diluted EPS for Q4 2025 was $8.14, up 44.6% year-over-year; adjusted EPS was $8.01, up 28.8%.

• Cash flow from operations reached $12.6 billion in 2025, up 20% from 2024.

• Consolidated adjusted EBITDA increased 12.1% year-over-year; adjusted EBITDA margin improved by 90 basis points.

Outlook and guidance

• 2026 revenue guidance: $76.5–$80 billion; adjusted EBITDA: $15.55–$16.45 billion.

• Net income guidance: $6.5–$7 billion; adjusted EPS: $29.10–$31.50.

• Capital spending guidance increased to $5–$5.5 billion for 2026.

• Expected 2–3% growth in equivalent admissions; full-year margins to remain slightly above 20%.

• Guidance assumes stable operating environment, volume growth, and excludes impacts from facility sales, legal claims, and certain Medicaid payments.