HCA posts 12% operating margin in Q1: 8 things to know

Nashville, Tenn.-based HCA Healthcare recorded an operating income of $2.29 billion (12% operating margin) in the first quarter of 2026, down from $2.33 billion (12.7% margin) during the same period last year, according to its April 24 financial report.

Eight things to know:

1. The for-profit system reported a net income of $1.62 billion for the three months ended March 31, compared to $1.61 billion during the same period last year.

2. HCA recorded total operating revenue of $19.1 billion in the first quarter of 2026, up from $18.3 billion during the same period in 2025.

3. Total operating expenses were $16.8 billion in the first quarter, up from $16 billion. Salaries and benefits totaled $8.3 billion, up from $8 billion. Supply costs were $2.9 billion, up from $2.8 billion. Other operating expenses totaled $4.2 billion, up from $3.8 billion.

4. HCA did not experience a typical seasonal volume increase in the first quarter of 2026, largely due to lower respiratory-related admissions. The system saw a 42% decrease year over year in those visits, and a 32% decrease in respiratory-related emergency room visits. A winter storm in January also negatively affected volumes in certain markets.

5. The unfavorable volume trends were mostly offset by the recognition of certain Medicaid supplemental programs that were not included in HCA’s initial 2026 guidance.

6. HCA reaffirmed its 2026 estimated guidance ranges that were previously issued in January. For full-year 2026, HCA is projecting a net income between $6.5 billion and $7 billion and an adjusted EBITDA between $15.6 and $16.5 billion. It is projecting revenue between $76.5 billion and $80 billion.

7. As of March 31, HCA operates 189 hospitals and about 2,600 ambulatory care sites in 19 states and the United Kingdom. On the same date in 2025, HCA operated 192 hospitals and about 2,500 ambulatory care sites in 20 states and the United Kingdom.

8. “The start of the year presented a dynamic environment for HCA Healthcare,” CEO Sam Hazen said in the report. “I want to recognize our colleagues for continuing to demonstrate a remarkable ability to adapt to changing conditions and deliver for our patients, communities, and stakeholders.”

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