Key Highlights

  • HCA shares are trading down 4.03% to $446.50, against a prior close of $465.26.
  • Third-quarter revenue rose 3.6% to $19.849 billion, and adjusted EPS rose 3.7% to $7.22.
  • A payer mix shift toward uninsured patients cut pre-tax income by about $400 million.
  • Same-facility inpatient surgeries fell 1.4% and outpatient surgeries fell 3.7%.
  • Full-year results are now expected in the upper half of guidance, with adjusted EBITDA guided to $15.4 billion to $16.1 billion.

Uninsured Volume Overshadows an Earnings and Revenue Beat

HCA Healthcare (NYSE:HCA) shares are trading down 4.03% to $446.50 after the hospital operator reported third-quarter results that beat estimates but carried a clear payer mix cost. Adjusted EPS of $7.22 compared with roughly $6.65 expected, and revenue of $19.849 billion topped expectations near $19.33 billion. Shares opened at $480.55, and an early gain of more than 5% reversed.

The company said more uninsured patients, mainly people who lost coverage on health insurance exchanges, reduced pre-tax income by about $400 million in the quarter. Management also pointed to improvement elsewhere, including faster growth in same-facility equivalent admissions, stronger insured revenue per equivalent admission and better cost results.

HCA Healthcare, based in Nashville, Tennessee, operates 189 hospitals and about 2,600 ambulatory sites of care across 19 states and the United Kingdom. Its 52-week range runs from $353.99 to $556.52.

Surgery Volumes Soften While Emergency Room Visits Climb

Same-facility admissions rose 2.7% and equivalent admissions rose 3.0%, while same-facility emergency room visits increased 5.1%. Inpatient surgeries fell 1.4% and outpatient surgeries fell 3.7%. Same-facility revenue per equivalent admission rose only 0.6%.

Net income attributable to the company declined 3.9% to $1.579 billion, though diluted EPS rose 4.5% to $7.27 as buybacks cut the diluted share count to 217.2 million from 236.2 million. Adjusted EBITDA rose 1.2% to $3.918 billion, and the adjusted EBITDA margin slipped to 19.7% from 20.2%. Other operating expenses climbed to 23.0% of revenue from 21.8%.

Guidance, Buybacks and Medicaid Supplemental Payments

HCA said full-year results should land in the upper half of the ranges it issued in July. The 2026 forecast calls for revenue of $77.0 billion to $79.5 billion, adjusted EBITDA of $15.4 billion to $16.1 billion and diluted EPS of $28.70 to $30.50.

Market commentary also pointed to management's view that 2027 earnings should be roughly consistent with 2026, and to an expected decline of $550 million to $650 million in Medicaid supplemental payments. The company repurchased 7.230 million shares for $2.970 billion in the quarter, with $4.240 billion left on its authorization, and declared a quarterly dividend of $0.78 per share payable December 29.

HCA ended the quarter with $908 million in cash and $50.493 billion of total debt. The stock carries a market cap of $96.67 billion, trailing EPS of $28.96 and a dividend yield of 0.68%.

Hospital peer Universal Health Services (NYSE:UHS) is also trading lower, while the State Street Health Care Select Sector SPDR ETF is little changed, down 0.09%. Elsewhere in healthcare services, Wells Fargo trimmed its price target on UnitedHealth Group (NYSE:UNH) on political uncertainty.

Coverage Losses on the Exchanges Remain the Variable to Watch

The net takeaway is a quarter of solid volumes and cash generation clouded by coverage losses. Investors will watch whether uninsured volume keeps rising, how Medicaid supplemental payments develop and whether results stay in the upper half of guidance.