HCA Q4 Deep Dive: Cost Discipline, Outpatient Investments, and Policy Headwinds Define Outlook

Stock Story

Hospital operator HCA Healthcare missed Wall Street’s revenue expectations in Q4 CY2025, but sales rose 6.7% year on year to $19.51 billion. The company’s full-year revenue guidance of $78.25 billion at the midpoint came in 1.1% below analysts’ estimates. Its GAAP profit of $8.14 per share was 9.2% above analysts’ consensus estimates.

HCA Healthcare (HCA) Q4 CY2025 Highlights:

Revenue: $19.51 billion vs analyst estimates of $19.71 billion (6.7% year-on-year growth, 1% miss)
EPS (GAAP): $8.14 vs analyst estimates of $7.46 (9.2% beat)
Adjusted EBITDA: $4.11 billion vs analyst estimates of $4.03 billion (21.1% margin, 2% beat)
EPS (GAAP) guidance for the upcoming financial year 2026 is $30.30 at the midpoint, beating analyst estimates by 1.9%
EBITDA guidance for the upcoming financial year 2026 is $16 billion at the midpoint, above analyst estimates of $15.82 billion
Operating Margin: 16.8%, up from 13.5% in the same quarter last year
Same-Store Sales rose 2.4% year on year, in line with the same quarter last year
Market Capitalization: $115.4 billion

StockStory’s Take

HCA Healthcare’s fourth quarter results were met with a significant positive response from the market, reflecting confidence in the company’s operational execution and margin improvements. Management credited the quarter’s performance to sustained volume growth across its networks, disciplined expense management, and continued investment in both inpatient and outpatient capacity. CEO Samuel Hazen emphasized that the company delivered its nineteenth consecutive quarter of volume growth and highlighted the benefits from network expansion and enhanced clinical capabilities, stating, “Our teams executed at a high level, we gained ground with our strategic agenda, and we stayed focused on the fundamentals.”

Looking ahead, HCA Healthcare’s guidance for the coming year is shaped by both anticipated policy headwinds and continued investment in digital transformation and network expansion. Management cited the expected impact of expiring premium tax credits and changes to Medicaid supplemental payments, while also outlining plans for further efficiency gains through its resiliency program. CFO Mike Marks noted, “We have confidence that we’ll be able to achieve $400 million of incremental cost savings in ’26 versus ’25,” and stressed that the company’s digital and AI initiatives are expected to drive long-term value and offset some of the regulatory challenges.

Key Insights from Management’s Remarks

Management attributed the quarter’s outperformance to strong volume growth, improved cost control, and network investments, while also highlighting the ongoing impact of policy changes and payer mix shifts.

Volume growth sustained: HCA Healthcare saw steady increases in admissions and patient encounters, driven by network investments and improved capacity management, with CEO Samuel Hazen noting that the company achieved record patient care activity during the year.
Expense management drove margin gains: CFO Mike Marks credited disciplined labor and supply cost controls, as well as operational efficiencies, for the company’s margin expansion, especially through the financial resiliency program targeting revenue integrity and cost reduction.
Payer mix shifts: Management called out continued growth in Medicare and Medicaid admissions, with Medicaid volumes rebounding to more typical levels following the completion of the redetermination process, while commercial admissions also increased modestly.
Outpatient expansion accelerated: The company invested heavily in outpatient facilities, adding roughly 100 new business units during the year, with management indicating that outpatient revenue growth outpaced inpatient revenue and that the pipeline for further acquisitions is robust.
Supplemental payments and policy dynamics: The quarter included a retroactive payment from Virginia and ongoing variability in state and federal supplemental payment programs, with management emphasizing the complexity and timing uncertainty of these payments as a recurring theme impacting quarterly results.

Drivers of Future Performance

HCA Healthcare’s outlook is shaped by regulatory headwinds, efficiency initiatives, and ongoing investment in technology and network expansion.

Policy and reimbursement headwinds: Management expects the expiration of enhanced premium tax credits and changes in Medicaid supplemental payments to create a significant drag on EBITDA, projecting a 15–20% decline in health exchange volumes and more uninsured patients, which could impact utilization and uncompensated care levels.
Resiliency and cost initiatives: The company plans to offset some of these headwinds with a $400 million cost savings program focused on digital transformation, automation, and expanded shared services, with management emphasizing the use of artificial intelligence to drive operational and administrative efficiencies.
Outpatient and network investments: Continued capital deployment toward outpatient facility expansion and new inpatient capacity is expected to support volume growth and diversify revenue streams, while management highlighted a strong pipeline for both greenfield projects and acquisitions, particularly in the outpatient segment.

Catalysts in Upcoming Quarters

In the quarters ahead, the StockStory team will be watching (1) the pace and effectiveness of HCA’s resiliency and cost-saving programs in offsetting policy headwinds, (2) the impact of expiring premium tax credits and Medicaid payment changes on patient volumes and uncompensated care, and (3) continued expansion and integration of outpatient facilities. Progress in digital transformation and the ability to adapt to evolving reimbursement environments will also be key indicators of execution.

HCA Healthcare currently trades at $504.39, up from $472.38 just before the earnings. Is the company at an inflection point that warrants a buy or sell? See for yourself in our full research report (it’s free).

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UnitedHealth and Humana among market cap stock movers on Tuesday

Investing.com

Tuesday’s market has seen significant swings in various stocks influenced by news and other factors. Today, stocks like United Health Group and Humana are experiencing notable movements. Below are highlights of some of the biggest stock movers, from mega-caps to small caps.

Mega-Cap Movers ($200 billion USD or higher):

United Health Group (UNH); Trump Administration Proposes Flat Rates for Medicare Advantage, CMS and White House Say -- WSJ: -17.64%
Oracle Corp (ORCL): -3.83%
Micron Tech (MU): +5.0%
Lam Research Corp (LRCX): +6.25%
Applied Matls Inc (AMAT): +4.87%
Intel Corp (INTC): +3.36%
Alibaba-exch (BABA): +1.88%
Apple Computer Inc (AAPL): +1.79%

Large-Cap Stock Movers ($10-$200 billion USD):

Humana Inc (HUM); Trump Administration Proposes Flat Rates for Medicare Advantage, CMS and White House Say -- WSJ: -18.91%
Roper Industries (ROP): -13.99%
Centene (CNC): -12.14%
Wellpoint Inc (ELV): -11.04%
Cvs Corp (CVS); Trump Administration Proposes Flat Rates for Medicare Advantage, CMS and White House Say -- WSJ: -10.9%
Corning Inc (GLW); Corning and Meta sign up to $6 billion deal for U.S. data centers: +16.65%
Cloudflare Inc (NET): +13.98%
Amark Preci (GOLD): +12.54%
HCA Holdings Inc (; HCA Healthcare beats Q4 earnings, stock falls on revenue miss: +9.54%
Regencell Bioscience Holdings (RGC): +9.21%

Mid-Cap Stock Movers ($2-$10 billion USD):

Commvault System (CVLT): -33.79%
Agilysys (AGYS); Agilysys shares tumble after Q3 earnings miss: -21.35%
Sanmina-SCI Corp (SANM); Sanmina shares tumble as revenue guidance falls short of expectations: -16.73%
Alignment Healthcare LLC (ALHC): -14.41%
Redwire (RDW); Redwire secures position on $151b MDA SHIELD contract: +29.85%
Kingsoft Cloud Holdings Ltd (KC): +10.91%
TECO Energy Inc-Exch (TE): +10.57%
Popular Inc (BPOP); Popular tops Q4 EPS by 50c, shares edge higher: +5.65%
Planet Labs PBC (PL): +8.29%
NantKwest (IBRX): -5.34%

Small-Cap Stock Movers ($300 million - $2 billion USD):

NovaBay Pharmaceuticals Inc (NBY): -34.13%
Apollo Medical (ASTH): -19.18%
World Acceptance (WRLD); World Acceptance misses Q3 EPS, shares fall on higher loan provisions: -17.96%
agilon health (AGL): -10.49%
New Fortress Energy LLC (NFE): -9.3%
Junee (SUPX): +33.56%
Richtech Robotics (RR): +22.08%
HUYA Inc (: +20.03%
Hyperliquid Strategies (PURR): +12.3%
MUU (MUU): +9.41%

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UnitedHealth, NextEra, Texas Instruments set to report earnings Tuesday

Investing.com

Earnings season continues as we prepare for another busy day of financial results. Below we highlight companies expected to report earnings the next trading day so you can position yourself ahead of potential market moves. Leading the action are industry giants UnitedHealth Group, NextEra Energy, Texas Instruments, Boeing, and Raytheon Technologies, whose reports could provide valuable insights into various sectors of the economy.

Earnings Before the Open:

• UnitedHealth Group (UNH) - Estimated EPS: $2.12, Estimated Revenue: $113.77B

• NextEra Energy Inc (NEE) - Estimated EPS: $0.5571, Estimated Revenue: $6.78B

• Boeing Co (BA) - Estimated EPS: -$0.4532, Estimated Revenue: $22.4B

• United Tech (RTX) - Estimated EPS: $1.47, Estimated Revenue: $22.69B

• Union Pacific (UNP) - Estimated EPS: $2.87, Estimated Revenue: $6.12B

• HCA Holdings Inc (HCA) - Estimated EPS: $7.45, Estimated Revenue: $19.67B

• Northrop Grumman (NOC) - Estimated EPS: $6.99, Estimated Revenue: $11.61B

• Sysco Corp (SYY) - Estimated EPS: $0.9768, Estimated Revenue: $20.78B

• Roper Industries (ROP) - Estimated EPS: $5.14, Estimated Revenue: $2.08B

• United Parcel (UPS) - Estimated EPS: $2.2, Estimated Revenue: $23.96B

• Paccar Inc (PCAR) - Estimated EPS: $1.07, Estimated Revenue: $6.03B

• Kimberly Clark (KMB) - Estimated EPS: $1.81, Estimated Revenue: $4.09B

• Synchrony Fin (SYF) - Estimated EPS: $2.04, Estimated Revenue: $3.84B

• Atlas Copco AB (ATLKY) - Estimated EPS: $0.1557, Estimated Revenue: $4.66B

• Atlas Copco (ATLCY) - Estimated EPS: $0.1557, Estimated Revenue: $4.66B

• Sandvik AB (SDVKY) - Estimated EPS: $0.3584, Estimated Revenue: $3.42B

• Invesco Ltd (IVZ) - Estimated EPS: $0.5722, Estimated Revenue: $1.24B

• American Airlines Group (AAL) - Estimated EPS: $0.3848, Estimated Revenue: $14.04B

• Polaris Industries (PII) - Estimated EPS: $0.0501, Estimated Revenue: $1.81B

• Applied Industrial Technologies (AIT) - Estimated EPS: $2.49, Estimated Revenue: $1.17B

• Commvault System (CVLT) - Estimated EPS: $0.9807, Estimated Revenue: $299.05M

• Popular Inc (BPOP) - Estimated EPS: $3.03, Estimated Revenue: $831.74M

• Community Bank System Inc (CBU) - Estimated EPS: $1.13, Estimated Revenue: $212.85M

• First BanCorp New Common Stock (FBP) - Estimated EPS: $0.5068, Estimated Revenue: $256.2M

• BBCN Bancorp (HOPE) - Estimated EPS: $0.2525, Estimated Revenue: $142.9M

• Jet Blue (JBLU) - Estimated EPS: -$0.4593, Estimated Revenue: $2.22B

• World Acceptance (WRLD) - Estimated EPS: $0.78, Estimated Revenue: $133.49M

• Camden National (CAC) - Estimated EPS: $1.32, Estimated Revenue: $66.17M

• Capital City Bank (CCBG) - Estimated EPS: $0.8867, Estimated Revenue: $64.65M

• Provident Financial Holdings (PROV) - Estimated EPS: $0.335, Estimated Revenue: $10.5M

• Sage Group PLC (SGPYY) - Estimated EPS not available, Estimated Revenue not available

Earnings After the Close:

• Texas Instru (TXN) - Estimated EPS: $1.29, Estimated Revenue: $4.45B

• Seagate Technology (STX) - Estimated EPS: $2.79, Estimated Revenue: $2.73B

• Packaging Corp (PKG) - Estimated EPS: $2.45, Estimated Revenue: $2.44B

• Boston Ppty (BXP) - Estimated EPS: $0.4907, Estimated Revenue: $861M

• Nextracker (NXT) - Estimated EPS: $0.70, Estimated Revenue: $745.13M

• F5 Networks Inc (FFIV) - Estimated EPS: $3.65, Estimated Revenue: $755.96M

• Ppg Industries (PPG) - Estimated EPS: $1.58, Estimated Revenue: $3.78B

• Manhattan Associa (MANH) - Estimated EPS: $1.13, Estimated Revenue: $264.68M

• Logitech International S.A.-Exch (LOGI) - Estimated EPS: $1.74, Estimated Revenue: $1.4B

• UMB Financial Corp (UMBF) - Estimated EPS: $2.7, Estimated Revenue: $677.77M

• K12 Inc (LRN) - Estimated EPS: $2.01, Estimated Revenue: $627.9M

• Qorvo Inc (QRVO) - Estimated EPS: $1.86, Estimated Revenue: $988.69M

• Greif Bros Corp (GEF) - Estimated EPS: $0.67, Estimated Revenue: $1.01B

• Greif Bros Corp B (GEFb) - Estimated EPS: $0.67, Estimated Revenue: $1.01B

• Enova International Inc (ENVA) - Estimated EPS: $3.17, Estimated Revenue: $838.59M

• Renasant Corp (RNST) - Estimated EPS: $0.78, Estimated Revenue: $275.85M

• Provident Financial Services Inc (PFS) - Estimated EPS: $0.555, Estimated Revenue: $225.35M

• WesBanco (WSBC) - Estimated EPS: $0.85, Estimated Revenue: $265.53M

• National Bak Hld (NBHC) - Estimated EPS: $0.8163, Estimated Revenue: $107.48M

• QCR Holdings (QCRH) - Estimated EPS: $1.99, Estimated Revenue: $106.87M

• First Commonwealth Financial Corp (FCF) - Estimated EPS: $0.4167, Estimated Revenue: $135.63M

• Trustmark Corp (TRMK) - Estimated EPS: $0.9109, Estimated Revenue: $206.64M

• HAFC (HAFC) - Estimated EPS: $0.7025, Estimated Revenue: $71.4M

• Orrstown Financial (ORRF) - Estimated EPS: $1.06, Estimated Revenue: $63.95M

• Flushing Financial (FFIC) - Estimated EPS: $0.35, Estimated Revenue: $62.27M

• Shore Bancshares (SHBI) - Estimated EPS: $0.4673, Estimated Revenue: $57.97M

• Bridgewater Bancshares Inc (BWB) - Estimated EPS: $0.41, Estimated Revenue: $38.08M

Be sure to check back daily for updates and insights into the earnings season and real-time results at Investing.com’s Earnings Calendar and Headlines section. Do you want to trade the earnings of the biggest companies like a pro? Then get InvestingPro now and access over 1000 metrics that will give you a significant advantage in the shark tank that is Wall Street. Click here.

This article was generated with the support of AI and reviewed by an editor. For more information see our T&C.

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What To Expect From HCA Healthcare’s (HCA) Q4 Earnings

Stock Story

HCA Healthcare

+4.08%

Hospital operator HCA Healthcare will be reporting earnings this Tuesday morning. Here’s what investors should know.

HCA Healthcare beat analysts’ revenue expectations by 3.3% last quarter, reporting revenues of $19.16 billion, up 9.6% year on year. It was a very strong quarter for the company, with an impressive beat of analysts’ full-year EPS guidance estimates and a beat of analysts’ EPS estimates.

Is HCA Healthcare a buy or sell going into earnings? Read our full analysis here, it’s free for active Edge members.

This quarter, analysts are expecting HCA Healthcare’s revenue to grow 7.7% year on year to $19.69 billion, improving from the 5.7% increase it recorded in the same quarter last year. Adjusted earnings are expected to come in at $7.47 per share.

Analysts covering the company have generally reconfirmed their estimates over the last 30 days, suggesting they anticipate the business to stay the course heading into earnings. HCA Healthcare has only missed Wall Street’s revenue estimates once over the last two years, exceeding top-line expectations by 1.9% on average.

With HCA Healthcare being the first among its peers to report earnings this season, we don’t have anywhere else to look to get a hint at how this quarter will unravel for healthcare providers & services stocks. However, there has been positive investor sentiment in the segment, with share prices up 2.9% on average over the last month. HCA Healthcare’s stock price was unchanged during the same time and is heading into earnings with an average analyst price target of $488.76 (compared to the current share price of $472.75).

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HCA Healthcare (HCA): Buy, Sell, or Hold Post Q3 Earnings?

Stock Story

HCA Healthcare

+4.08%

Since January 2021, the S&P 500 has delivered a total return of 82.8%. But one standout stock has more than doubled the market - over the past five years, HCA Healthcare has surged 183% to $470.79 per share. Its momentum hasn’t stopped as it’s also gained 29.1% in the last six months thanks to its solid quarterly results, beating the S&P by 19%.

Is now still a good time to buy HCA? Or is this a case of a company fueled by heightened investor enthusiasm? Find out in our full research report, it’s free.

Why Are We Positive On HCA Healthcare?

With roots dating back to 1968 and a network spanning 20 states, HCA Healthcare operates a network of 190 hospitals and 150+ outpatient facilities providing a full range of medical services across the US and England.

1. Economies of Scale Give It Negotiating Leverage with Suppliers

Larger companies benefit from economies of scale, where fixed costs like infrastructure, technology, and administration are spread over a higher volume of goods or services, reducing the cost per unit. Scale can also lead to bargaining power with suppliers, greater brand recognition, and more investment firepower. A virtuous cycle can ensue if a scaled company plays its cards right.

With $74.37 billion in revenue over the past 12 months, HCA Healthcare is one of the most scaled enterprises in healthcare. This is particularly important because hospital chains companies are volume-driven businesses due to their low margins.

2. Outstanding Long-Term EPS Growth

We track the long-term change in earnings per share (EPS) because it highlights whether a company’s growth is profitable.

HCA Healthcare’s EPS grew at an astounding 21.2% compounded annual growth rate over the last five years, higher than its 7.9% annualized revenue growth. This tells us the company became more profitable on a per-share basis as it expanded.

HCA Healthcare Trailing 12-Month EPS (GAAP)

3. Increasing Free Cash Flow Margin Juices Financials

Free cash flow isn't a prominently featured metric in company financials and earnings releases, but we think it's telling because it accounts for all operating and capital expenses, making it tough to manipulate. Cash is king.

As you can see below, HCA Healthcare’s margin expanded by 11.2 percentage points over the last five years. This is encouraging, and we can see it became a less capital-intensive business because its free cash flow profitability rose while its operating profitability fell. HCA Healthcare’s free cash flow margin for the trailing 12 months was 10.9%.

HCA Healthcare Trailing 12-Month Free Cash Flow Margin

Final Judgment

These are just a few reasons HCA Healthcare is a high-quality business worth owning, and with its shares topping the market in recent months, the stock trades at 16.5× forward P/E (or $470.79 per share). Is now a good time to buy? See for yourself in our comprehensive research report, it’s free.

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Why Healthcare's Stock-Market Winners and Losers Could Soon Trade Places — Heard on the Street — WSJ

Dow Jones Newswires

By David Wainer

For the past few years, as Americans poured back into doctors' offices and operating rooms, U.S. healthcare split into clear winners and losers.

Hospitals and other providers — businesses that make money on volume — thrived. Insurers, which bear the risk of paying for that care, didn't.

The stock market reflected this divide with brutal clarity. Since early 2020, shares of hospital operator Tenet Healthcare have quintupled while HCA Healthcare has more than tripled. Shares of the nation's largest health insurers such as UnitedHealth Group and Centene, meanwhile, have languished.

That gap now looks poised to narrow.

For the past five years, U.S. hospitals have enjoyed a "Goldilocks" environment. First, the pandemic-era safety net: The Biden administration's emergency funding supercharged Medicaid and the Affordable Care Act exchanges, adding coverage to millions of people and slashing the national uninsured rate. Second, a tight labor market meant millions of Americans moved into high-margin, employer-sponsored insurance, leaving stingier government plans behind.

Hospitals are still enjoying boom times, and analysts expect industry leader HCA to post strong earnings growth in the years ahead. But the stock's current valuation — about 16 times forward earnings, roughly 20% above its 10-year average — may already reflect that optimism. That comes as medium- and long-term headwinds are mounting.

Last year, Trump's tax legislation included a reduction to federal healthcare outlays by roughly $1 trillion over the next decade, with most cuts hitting Medicaid. Enhanced ACA premium subsidies that helped drive pandemic--era enrollment have expired.

Without an extension, marketplace enrollment could start to fall. (Republicans and Democrats have cited progress toward a compromise, though that still doesn't solve long-term questions about the ACA.) The One Big Beautiful Bill also tightened state financing rules that many hospitals used to augment low Medicaid reimbursement with those changes phasing in over the coming years.

A cooling labor market is another looming challenge. Unemployment has risen from roughly 4% in early 2025 to 4.4% in the latest reading. If that keeps creeping up, it raises the risk of higher bad debt, says Leerink analyst Whit Mayo.

"We're starting to see credit card, auto loan, and mortgage delinquencies tick up," he says. "It's not huge, but it's a sign of a weaker consumer. When uninsured patients can't pay their bills, hospitals face higher bad debt."

For insurers — whose stocks badly underperformed last year, save for CVS Health — the worst may be behind them, particularly in Medicare Advantage.

While policy risks remain, one key driver has improved sharply: government payment rates for Medicare Advantage. Last year, the Trump administration announced a boost in Medicare Advantage rates of more than 5% for 2026.

That was well above what the departing Biden administration had proposed. Initial government proposals for 2027 are expected to be released this month, and analysts are bullish.

With insurer profit margins currently depressed, a rebound is less a question of if than when.

Bernstein analyst Lance Wilkes notes that margins for government programs — Medicare Advantage, Medicaid and Marketplace plans — are down roughly 50% or more from historic levels. Low profitability has prompted some insurers to pull back, thinning competition. As government rates rise and competitive pressures ease, the sector is positioned to recover. That is a potential boon for valuations.

There are multiple ways to play a Medicare rebound, but two stand out.

UnitedHealth Group is the industry leader whose stock took a beating last year mainly because of its Medicare business. The shares lost a third of their value.

The company's forward earnings multiple of around 18.6 looks reasonable though not cheap. But keep in mind that the earnings denominator is historically depressed. If the company's profitability bounces back this year, much like what happened with CVS last year, the stock will respond positively.

But UnitedHealth isn't necessarily out of the political crosshairs: A Senate committee investigating the company said it deployed aggressive tactics to collect payment-boosting diagnoses for its Medicare Advantage members.

Leerink's Mayo says new management is doing a thorough cleanup, divesting assets the company bought over the years that no longer make sense to hold. The company has also retrenched in Medicare, getting out of unprofitable areas.

Another way to bet on Medicare is by investing in upstart Alignment Healthcare. The smaller insurer's tech-driven care model has a proven record of lowering medical costs, even in a volatile Medicare Advantage market, Mayo notes. The key test for the company over the long term is whether it can expand beyond its core market of California.

After years of favoring providers over payers, the economics of U.S. healthcare may finally be turning.

Write to David Wainer at david.wainer@wsj.com

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