HCA Healthcare reported adjusted earnings per share of $8.01 in the fourth quarter of 2025, a 28.8% increase from $6.22 in the same period a year earlier. Revenue rose 6.7% year over year to $19.51 billion, driven by a 2.5% increase in equivalent admissions and a 2.9% gain in revenue per equivalent admission. Adjusted EBITDA climbed 10.8% to $4.11 billion, and operating margin expanded to 21.1% from 20.3%, reflecting higher patient volumes and improved pricing trends across HCA’s network of 186 hospitals and 2,600 outpatient sites.

HCA issued guidance for 2026 adjusted earnings between $29.10 and $31.50 per share, well above consensus estimates. The company projects revenue of $76.5 billion to $80.0 billion, implying growth of roughly 7% to 10% year over year. Management cited expected benefits from ongoing cost‐containment initiatives, favorable case-mix shifts, and continued strength in elective procedures, particularly joint replacements and cardiac services, which accounted for approximately 15% of admissions in 2025.

During 2025, HCA allocated $9.8 billion to its share repurchase program, reducing outstanding common shares by 5.2%. The buyback program has shaved nearly 12% off the share count over the past two years, amplifying earnings per share growth and returning more than $12 billion to investors via repurchases and dividends. Management reaffirmed its target to deploy at least $10 billion in buybacks during 2026, contingent on free cash flow generation and capital expenditure requirements for facility upgrades.

Following a more than 40% total return over the last 12 months, HCA’s valuation stands near 16 times trailing earnings, and free cash flow yield sits around 6%. While the company has expanded operating margins by 80 basis points over the past year, analysts warn that benefits from supply‐chain savings and labor efficiencies may plateau. Potential headwinds include changes to Medicaid reimbursement rates and revisions to Affordable Care Act subsidies, which could weigh on revenue growth and margin expansion if enacted without offsetting cost support measures.