HCA FY2025 Q4 IMPROVING

HCA Healthcare, Inc. earnings call

Jan 27, 2026 · 05:00 ET Frank MorganMike MarksSam Hazen

Buzzberg read

2026 EBITDA guidance reflects $600M-$900M exchange headwind

HCA reported solid Q4 2025 results with 6.7% revenue growth, 11% adjusted EBITDA growth, and strong cash flow. Management provided FY2026 guidance that includes $600-$900M headwind from exchange subsidies and $250-$450M decline in supplemental payments, partially offset by $400M in resiliency savings. They maintained a constructive tone on long-term demand and margins, while increasing capex to $5-$5.5B. Q4 same-facility admissions +2.4%, equivalent admissions +2.5%, inline with 2-3% growth target.

Buzzberg read 2026 EBITDA guidance reflects $600M-$900M exchange headwind HCA reported solid Q4 2025 results with 6.7% revenue growth, 11% adjusted EBITDA growth, and strong cash flow. Management provided FY2026 guidance that includes $600-$900M headwind from exchange subsidies and $250-$450M decline in supplemental payments, partially offset by $400M in resiliency savings. They maintained a constructive tone on long-term demand and margins, while increasing capex to $5-$5.5B. Q4 same-facility admissions +2.4%, equivalent admissions +2.5%, inline with 2-3% growth target. Read full analysisCollapse analysis

FY2025 adjusted EBITDA +12.1%, margin improved 90 bps; cash flow from operations $12.6B (+20% YoY).
FY2026 revenue guide $76.5-80B, EPS $29.10-31.50, capex $5-5.5B; margin expected slightly above 20%.
Exchange subsidy expiration and administrative reforms expected to reduce EBITDA by $600-900M.

Revenue $19.513B +2% QoQ

EPS $8.01 +15% QoQ

Gross margin 41.9% reported

Op margin 16.29% reported

What changed this quarter

Guidance

2026 EBITDA guidance reflects $600M-$900M exchange headwind

Guidance · revenue to $78.25B

Cost Efficiency

Resiliency program to offset $400M of exchange impact

Q4 same-facility admissions +2.4%, equivalent admissions +2.5%, inline with 2-3% growth target.

Medicaid

Texas supplemental payment pause contributes to EBITDA decline

FY2025 adjusted EBITDA +12.1%, margin improved 90 bps; cash flow from operations $12.6B (+20% YoY).

AI investments across clinical, operational, and administrative domains

Management is investing heavily in AI across administrative, operational, and clinical domains, with the goal of driving efficiencies, improving patient care, and creating long-term value. They are implementing AI in revenue cycle, supply chain, and clinical decision support…

AI, capex & demand read

Platform & monetization

Demand

Bookings & conversion

Exchange volume modeled to decline 15-20% in 2026. Management expressed confidence in their ability to navigate policy headwinds and execute on strategic initiatives, citing a strong balance sheet, robust resiliency programs, and a clear technology roadmap.

Capex

Investment and capacity

Capital expenditures are expected to increase to $5 billion to $5.5 billion in 2026, funded by strong cash flow, to support organic growth, including high-acuity programs, new access points, and inpatient capacity.

Tone · Confident

Management expressed confidence in their ability to navigate policy headwinds and execute on strategic initiatives, citing a strong balance sheet, robust resiliency programs, and a clear technology roadmap.

Forward guidance

ImprovingGuidance · revenue to $78.25B · was RAISED last Q

Forward guidance
Metric	Period	Range	Midpoint	Status
Capex	FY2026	$5B–$5.5B	$5.25B	INITIATED
EPS	FY2026	$29.10–$31.50	$30.30	INITIATED
Revenue	FY2026	$76.5B–$80B	$78.25B	INITIATED

Guidance credibility

1 / 1met or beat

Guidance credibility
Issued	Metric	Target	Guide	Actual	Outcome
FY2025 Q3	Capex	FY2025	$5B	$4.9B	Met / beat