HCA Healthcare (HCA) Q4 2025 earnings summary

Executive summary

• Achieved 19 consecutive quarters 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.

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%.

• Adjusted EBITDA margin improved by 90 basis points for the year; diluted EPS as adjusted up 28.5%.

• Cash flow from operations reached $12.6B for 2025, up 20% from 2024.

• Diluted EPS for Q4 2025 was $8.14, up 44.6% year-over-year; full-year diluted EPS was $28.33, up from $22.00 in 2024.

Outlook and guidance

• 2026 revenue guidance: $76.5B–$80B; adjusted EBITDA: $15.55B–$16.45B; net income: $6.5B–$7B.

• Diluted EPS guidance: $29.10–$31.50; capital spending increased to $5B–$5.5B.

• Expect 2%–3% growth in equivalent admissions; anticipate $600M–$900M adverse EBITDA impact from health insurance exchanges, partially offset by $400M in resiliency initiatives.

• Supplemental payment net benefit expected to decline $250M–$450M; 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.