How strong was HCA's underlying Q4 2025 performance once one-time items are removed?

Excluding gains and losses on facility sales, Q4 EPS was $8.01 versus $6.22 a year earlier, up 28.8%. Adjusted EBITDA grew 10.8% to $4.114 billion. Growth was helped by the lapping of roughly $200 million of hurricane-related costs and lost revenue in Q4 2024, so the comparison is somewhat flattered. Volume growth of about 2.4% to 2.5% and pricing up about 2.9% per equivalent admission provided the underlying support.

Why did operating cash flow decline in Q4 2025, and does it signal a problem?

Q4 operating cash flow was $2.359 billion versus $2.559 billion in Q4 2024. The decline was driven by about $1.3 billion of estimated tax payments that were deferred into Q4 because of IRS relief for Tennessee taxpayers affected by April 2025 severe weather. This is largely a timing effect, not a sign of deteriorating cash generation. Full-year 2025 operating cash flow was $12.636 billion, up from $10.514 billion in 2024.

How is HCA funding its share repurchases and dividend while carrying substantial debt?

HCA had $46.492 billion of total debt and $1.040 billion of cash at year end 2025, and $5.779 billion of credit facility availability. In 2025, the company repurchased $10.067 billion of stock, far exceeding operating cash flow after capex, and funded the gap with $8.474 billion of new long-term debt issuance and net short-term borrowings of $2.202 billion. The stockholders' deficit attributable to HCA deepened to $(6.027) billion. The new $10 billion authorization will require continued access to debt markets or stronger cash generation to sustain at this pace. The filing does not state a funding plan for the new program.

What are the main risks and assumptions behind the 2026 guidance?

Guidance assumes a mostly stable operating environment, stable payer mix, and volume growth. It excludes facility gains and losses, debt retirement losses, legal claim costs, and impairments. Key risks named in the filing include the expiration of enhanced ACA marketplace premium tax credits at year end 2025, which may reduce exchange enrollment and increase uninsured volume; OBBBA-related Medicaid and Medicare changes; tariffs and supply costs; labor costs and staffing; uncertain state Medicaid supplemental payments, which are excluded from guidance; and potential natural disasters, as in 2024.

What does the 2026 EPS guidance imply relative to 2025?

The 2026 diluted EPS range of $29.10 to $31.50 has a midpoint of about $30.30. That is roughly 7% above 2025 GAAP diluted EPS of $28.33 and about 9% above 2025 EPS as adjusted of $28.21. The guidance assumes about 223.5 million diluted shares, versus 239.5 million in 2025, so much of the EPS growth is driven by the lower share count from buybacks rather than by net income growth. Guided net income attributable to HCA of $6.495 to $7.035 billion implies a midpoint roughly flat to modestly higher than 2025's $6.784 billion.

HCA 8-K: Earnings & Results & Regulation FD

01—Abstract

Summary

Summary of the 8-K filed January 27, 2026. Cited figures are marked; the original filing is the authoritative source.

HCA Healthcare reported fourth-quarter 2025 results on January 27, 2026 that beat its own trajectory on the bottom line.

Q4 revenue rose 6.7% to $19.513 billion^a, GAAP net income attributable to HCA grew 30.6% to $1.878 billion, and diluted EPS rose 44.6% to $8.14. Excluding facility gains and losses, EPS, as adjusted, rose 28.8% to $8.01, and Adjusted EBITDA grew 10.8% to $4.114 billion (21.1% margin). Operating volumes were solid: same facility admissions rose 2.4%, same facility equivalent admissions rose 2.5%, and revenue per equivalent admission rose 2.9%.

Comparisons are flattered by roughly $200 million^b (about $0.60 per share) of Hurricane Helene and Milton impacts in Q4 2024, and Q4 2024 also carried a $195 million facility loss. Full-year 2025 revenue was $75.6 billion, net income attributable to HCA was $6.784 billion ($28.33 diluted EPS), and Adjusted EBITDA was $15.566 billion. Cash generation and capital allocation are the key points for investors.

Q4 operating cash flow fell to $2.359 billion^c from $2.559 billion, but that figure was depressed by about $1.3 billion of tax payments deferred into Q4 because of IRS relief tied to April 2025 Tennessee severe weather. Full-year operating cash flow was $12.636 billion, and capex was $4.944 billion. HCA repurchased $10.067 billion of stock during 2025, including $2.558 billion in Q4.

The Board authorized a new $10 billion^d repurchase program with no time limit, and declared a $0.78 quarterly dividend payable March 31, 2026. Total debt was $46.492 billion at year end, against cash of $1.040 billion. Leverage is high relative to the equity base, since stockholders' deficit attributable to HCA widened to $(6.027) billion.

For 2026, management guided to revenue of $76.5 to $80.0 billion, Adjusted EBITDA of $15.55 to $16.45 billion, and diluted EPS of $29.10 to $31.50 on about 223.5 million shares. Capex is expected at $5.0 to $5.5 billion. The guidance assumes a mostly stable operating environment and excludes facility gains and losses, debt retirement losses, legal claim costs, and impairments.

It also reflects headwinds from the expiration of enhanced ACA marketplace premium tax credits at year end 2025, the OBBBA, tariffs, and uncertain Medicaid supplemental payments. The guided EPS midpoint of about $30.30 implies modest growth over 2025's $28.33, helped by a lower share count.

02—Key points

Key Highlights

Q4 2025 GAAP diluted EPS was $8.14, up 44.6% year over year; EPS as adjusted was $8.01, up 28.8%, and the comparison benefits from Q4 2024 hurricane impacts of about $0.60 per share.
Q4 2025 revenue grew 6.7% to $19.513 billion, with same facility equivalent admissions up 2.5% and revenue per equivalent admission up 2.9%.
Adjusted EBITDA reached $4.114 billion in Q4 (21.1% margin) and $15.566 billion for full-year 2025 (20.6% margin).
Q4 operating cash flow of $2.359 billion was reduced by about $1.3 billion of tax payments deferred from earlier in 2025 due to Tennessee storm relief, so underlying cash generation was stronger than the headline suggests.
The Board authorized a new $10 billion share repurchase program with no time limit, following $10.067 billion of buybacks in 2025 and $750 million remaining under the prior authorization.
A quarterly dividend of $0.78 per share was declared, payable March 31, 2026 to holders of record on March 17, 2026.
2026 guidance calls for revenue of $76.5-80.0 billion, Adjusted EBITDA of $15.55-16.45 billion, and diluted EPS of $29.10-31.50, with capex of $5.0-5.5 billion.

03—Questions

Frequently Asked Questions

How strong was HCA's underlying Q4 2025 performance once one-time items are removed?
Excluding gains and losses on facility sales, Q4 EPS was $8.01 versus $6.22 a year earlier, up 28.8%. Adjusted EBITDA grew 10.8% to $4.114 billion. Growth was helped by the lapping of roughly $200 million of hurricane-related costs and lost revenue in Q4 2024, so the comparison is somewhat flattered. Volume growth of about 2.4% to 2.5% and pricing up about 2.9% per equivalent admission provided the underlying support.
Why did operating cash flow decline in Q4 2025, and does it signal a problem?
Q4 operating cash flow was $2.359 billion versus $2.559 billion in Q4 2024. The decline was driven by about $1.3 billion of estimated tax payments that were deferred into Q4 because of IRS relief for Tennessee taxpayers affected by April 2025 severe weather. This is largely a timing effect, not a sign of deteriorating cash generation. Full-year 2025 operating cash flow was $12.636 billion, up from $10.514 billion in 2024.
How is HCA funding its share repurchases and dividend while carrying substantial debt?
HCA had $46.492 billion of total debt and $1.040 billion of cash at year end 2025, and $5.779 billion of credit facility availability. In 2025, the company repurchased $10.067 billion of stock, far exceeding operating cash flow after capex, and funded the gap with $8.474 billion of new long-term debt issuance and net short-term borrowings of $2.202 billion. The stockholders' deficit attributable to HCA deepened to $(6.027) billion. The new $10 billion authorization will require continued access to debt markets or stronger cash generation to sustain at this pace. The filing does not state a funding plan for the new program.
What are the main risks and assumptions behind the 2026 guidance?
Guidance assumes a mostly stable operating environment, stable payer mix, and volume growth. It excludes facility gains and losses, debt retirement losses, legal claim costs, and impairments. Key risks named in the filing include the expiration of enhanced ACA marketplace premium tax credits at year end 2025, which may reduce exchange enrollment and increase uninsured volume; OBBBA-related Medicaid and Medicare changes; tariffs and supply costs; labor costs and staffing; uncertain state Medicaid supplemental payments, which are excluded from guidance; and potential natural disasters, as in 2024.
What does the 2026 EPS guidance imply relative to 2025?
The 2026 diluted EPS range of $29.10 to $31.50 has a midpoint of about $30.30. That is roughly 7% above 2025 GAAP diluted EPS of $28.33 and about 9% above 2025 EPS as adjusted of $28.21. The guidance assumes about 223.5 million diluted shares, versus 239.5 million in 2025, so much of the EPS growth is driven by the lower share count from buybacks rather than by net income growth. Guided net income attributable to HCA of $6.495 to $7.035 billion implies a midpoint roughly flat to modestly higher than 2025's $6.784 billion.

04—Continue

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