Free cash flow margins have compressed to 4.7% in 2026Q1, while management continues to prioritize aggressive capital allocation, including quarterly buybacks that have frequently exceeded $2B.
| Metric | TTM | Dec'25 | Dec'24 | Dec'23 | Dec'22 | Dec'21 | Dec'20 | Dec'19 | Dec'18 | Dec'17 | Dec'16 | Dec'15 | Dec'14 | Dec'13 | Dec'12 | Dec'11 | Dec'10 | Dec'09 | Dec'08 | Dec'07 | Dec'06 | Dec'05 | Dec'04 | Dec'03 | Dec'02 | Dec'01 | Dec'00 | Dec'99 | Dec'98 | Dec'97 | Dec'96 |
|---|
| Cash from Operations | 13B | 12.64B | 10.51B | 9.43B | 8.52B | 8.96B | 9.23B | 7.6B | 6.76B | 5.43B | 5.65B | 4.73B | 4.45B | 3.68B | 4.17B | 3.93B | 3.08B | 2.75B | 1.8B | 1.4B | 1.84B | 3.16B | 3.05B | 2.17B | 2.75B | 1.41B | 1.55B | 1.22B | 1.92B | 1.48B | 2.62B |
| Operating CF Margin % | - | 16.71% | 14.89% | 14.52% | 14.15% | 15.25% | 17.91% | 14.81% | 14.48% | 12.44% | 13.63% | 11.93% | 12.05% | 10.77% | 12.65% | 12.1% | 10.05% | 9.14% | 6.33% | 5.2% | 7.24% | 12.92% | 12.97% | 9.93% | 13.94% | 7.87% | 9.28% | 7.34% | 10.26% | 7.88% | 13.16% |
| Operating CF Growth % | 153.4% | 20.18% | 11.48% | 10.67% | -4.88% | -2.96% | 21.44% | 12.44% | 24.6% | -4.02% | 19.41% | 6.43% | 20.87% | -11.86% | 6.15% | 27.49% | 12.3% | 52.87% | 28.72% | -24.34% | -41.6% | 3.61% | 40.77% | -21.24% | 94.62% | -8.66% | 26.49% | -36.17% | 29.2% | -43.42% | 16.28% |
| Net Income | 6.79B | 6.78B | 6.66B | 5.24B | 6.83B | 7.72B | 4.39B | 4.14B | 4.39B | 2.74B | 3.43B | 2.7B | 2.37B | 2B | 2.01B | 2.84B | 1.57B | 1.38B | 673M | 874M | 1.04B | 1.42B | 1.25B | 1.33B | 833M | 886M | 219M | 657M | 532M | 126M | 1.5B |
| Depreciation & Amortization | 3.59B | 3.52B | 3.31B | 3.08B | 2.97B | 2.85B | 2.72B | 2.6B | 2.28B | 2.13B | 1.97B | 1.9B | 1.82B | 1.75B | 1.68B | 1.47B | 1.42B | 1.43B | 1.42B | 1.43B | 1.39B | 1.37B | 1.25B | 1.11B | 1.01B | 1.05B | 1.03B | 1.09B | 1.25B | 1.24B | 1.16B |
| Stock-Based Compensation | 99M | 0 | 360M | 0 | 341M | 440M | 362M | 347M | 268M | 270M | 251M | 239M | 163M | 113M | 56M | 26M | 32M | 40M | 32M | 24M | 324M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Deferred Taxes | 388M | 0 | 22M | 229M | 571M | -70M | 41M | 250M | 74M | 433M | 123M | -160M | -83M | 143M | 96M | 1.71B | 2.85B | 169M | 2.78B | 1.81B | 1.44B | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -163M | 0 |
| Other Non-Cash Items | -904M | 1.6B | 269M | 1.34B | -1.04B | -1.48B | 443M | 352M | -281M | 145M | -161M | 378M | 439M | 89M | 231M | 842M | 58M | 2.83B | 261M | 878M | 591M | 2.64B | 3.13B | 1.86B | 2.54B | 1.08B | 2.03B | 1.16B | 1.58B | 1.92B | 71M |
| Working Capital Changes | 2.79B | 728M | -106M | -457M | -1.15B | -503M | 1.28B | -88M | 33M | -296M | 42M | -323M | -264M | -414M | 107M | -2.95B | -2.85B | -3.09B | -3.37B | -3.62B | -2.94B | -2.28B | -2.58B | -2.14B | -1.63B | -1.6B | -1.74B | -1.69B | -1.45B | -1.64B | -110M |
| Change in Receivables | -230M | -94M | -799M | -935M | -797M | -962M | 327M | -326M | -423M | -4.64B | -3.25B | -4.11B | -3.65B | -4.39B | -3.9B | -3.25B | -2.79B | -3.18B | -3.33B | 0 | 0 | -2.65B | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Change in Inventory | 286M | -154M | 334M | -126M | -59M | -540M | -304M | -158M | -242M | -69M | -112M | -314M | -232M | -19M | -122M | -18M | -287M | -191M | 159M | -241M | -12M | 28M | -46M | 32M | -88M | -39M | 90M | -119M | -39M | 25M | -29M |
| Change in Payables | 676M | 666M | 359M | 604M | -296M | 999M | 1.25B | 396M | 698M | 374M | 144M | 192M | 3.88B | 4.41B | 4.02B | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Cash from Investing | -5.24B | -4.99B | -4.93B | -5.32B | -3.39B | -2.64B | -3.39B | -5.72B | -3.9B | -4.28B | -3.24B | -2.58B | -2.92B | -2.35B | -2.06B | -3B | -1.04B | -1.03B | -1.47B | -479M | -1.31B | -1.68B | -1.69B | -2.86B | -1.74B | -1.3B | -1.09B | 925M | 970M | -2.75B | -2.25B |
| Capital Expenditures | -5.07B | -4.94B | -4.88B | -4.74B | -4.39B | -3.58B | -2.83B | -4.16B | -3.57B | -3.02B | -2.76B | -2.38B | -2.18B | -1.94B | -1.86B | -1.68B | -1.32B | -1.32B | -1.6B | -1.44B | -1.86B | -1.59B | -1.51B | -1.84B | -1.72B | -1.37B | -1.16B | -1.29B | -1.25B | -1.42B | -1.4B |
| CapEx % of Revenue | 6.64% | 6.54% | 6.9% | 7.3% | 7.3% | 6.09% | 5.5% | 8.1% | 7.65% | 6.91% | 6.65% | 5.99% | 5.89% | 5.68% | 5.64% | 5.17% | 4.32% | 4.38% | 5.64% | 5.38% | 7.32% | 6.51% | 6.44% | 8.43% | 8.71% | 7.63% | 6.93% | 7.73% | 6.72% | 7.56% | 7.03% |
| Acquisitions | -324M | -128M | 62M | -442M | 1.01B | 1.05B | -500M | -1.62B | -445M | -1.21B | -576M | -278M | -715M | -448M | -228M | -1.4B | -196M | -20M | 108M | 735M | 539M | 194M | 4M | -745M | 11M | 280M | -23M | 805M | 1.84B | -411M | -816M |
| Investments | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| Other Investing | 9M | 12M | -120M | -131M | -7M | -121M | -58M | 59M | 60M | -52M | 96M | 70M | -27M | 45M | 27M | 85M | 482M | -1M | 25M | 230M | 19M | -283M | -179M | -279M | -33M | -210M | 91M | 1.41B | 674M | -1.05B | 185M |
| Cash from Financing | -7.88B | -8.55B | -4.58B | -4.09B | -5.66B | -6.66B | -4.68B | -1.77B | -3.08B | -1.06B | -2.51B | -1.98B | -1.38B | -1.63B | -1.78B | -976M | -1.95B | -1.86B | -258M | -1.16B | -240M | -1.4B | -1.35B | 650M | -934M | -342M | -336M | -2.25B | -2.7B | 1.26B | -489M |
| Debt Issued (Net) | 3.08B | 3.21B | 3.21B | 1.29B | 3.29B | 3.25B | -3.22B | 567M | -344M | 1.51B | 815M | 778M | 778M | -692M | 1.72B | -1.59B | 2.53B | -1.53B | -260M | -1.25B | 17.59B | -106M | 1.78B | 1.57B | -466M | 608M | 922M | -535M | -2.66B | 2.38B | -423M |
| Equity Issued (Net) | -9.13B | -10.07B | -6.04B | -3.81B | -7B | -8.21B | -441M | -1.03B | -1.53B | -2.05B | -2.75B | -2.4B | -1.75B | -500M | 0 | 1B | 0 | 0 | 0 | 100M | -20.91B | -847M | -2.88B | -949M | -15M | -1.29B | -677M | -1.88B | 8M | -1.08B | 0 |
| Dividends Paid | -682M | -679M | -690M | -661M | -653M | -624M | -153M | -550M | -487M | 0 | 0 | 0 | -7M | -16M | -3.15B | -31M | -4.26B | 0 | 0 | 0 | -201M | -258M | -199M | -39M | -40M | -42M | -44M | 0 | 0 | 0 | -54M |
| Share Repurchases | -9.13B | -10.07B | -6.04B | -3.81B | -7B | -8.21B | -441M | -1.03B | -1.53B | -2.05B | -2.75B | -2.4B | -1.75B | -500M | 0 | -1.5B | 0 | 0 | 0 | 0 | -21.02B | -1.86B | -3.11B | -1.11B | -282M | -1.51B | 0 | 0 | 0 | -1.08B | 0 |
| Other Financing | -1.16B | -1.01B | -1.05B | -917M | -1.29B | -1.07B | -866M | -757M | -714M | -519M | -572M | -357M | -399M | -417M | -356M | -359M | -223M | -336M | 2M | -3M | 3.27B | -189M | -41M | 65M | -413M | 385M | -537M | 164M | -49M | -42M | -12M |
| Net Change in Cash | -120M | -893M | 998M | 27M | -543M | -342M | 1.17B | 119M | -230M | 86M | -95M | 175M | 152M | -291M | 332M | -38M | 99M | -153M | 72M | -241M | 298M | 78M | 14M | -46M | 76M | -229M | 124M | -107M | 187M | -3M | -119M |
| Free Cash Flow | 7.93B | 7.69B | 5.64B | 4.69B | 4.13B | 5.38B | 6.4B | 3.44B | 3.19B | 2.41B | 2.89B | 2.36B | 2.27B | 1.74B | 2.31B | 2.25B | 1.76B | 1.43B | 197M | -48M | -20M | 1.57B | 1.54B | 328M | 1.03B | 43M | 392M | -64M | 661M | 61M | 1.22B |
| FCF Margin % | 10.38% | 10.17% | 7.99% | 7.21% | 6.85% | 9.16% | 12.41% | 6.71% | 6.83% | 5.53% | 6.97% | 5.95% | 6.15% | 5.08% | 7.01% | 6.93% | 5.74% | 4.76% | 0.69% | -0.18% | -0.08% | 6.41% | 6.54% | 1.5% | 5.23% | 0.24% | 2.35% | -0.38% | 3.54% | 0.32% | 6.13% |
| FCF Growth % | 60.21% | 36.41% | 20.31% | 13.57% | -23.32% | -15.87% | 85.74% | 8.03% | 32.23% | -16.66% | 22.64% | 3.83% | 30.8% | -24.9% | 2.62% | 28.07% | 23.08% | 625.89% | 510.42% | -140% | -101.28% | 2.02% | 368.29% | -68.22% | 2300% | -89.03% | 712.5% | -109.68% | 983.61% | -95% | 67.95% |
| FCF per Share | 34.97 | 33.34 | 21.54 | 16.96 | 14.01 | 16.37 | 18.52 | 9.89 | 8.97 | 6.48 | 7.31 | 5.53 | 5.04 | 3.76 | 5.03 | 4.54 | 4.02 | 4.10 | 0.56 | -0.14 | -0.05 | 3.50 | 3.18 | 0.64 | 1.97 | 0.08 | 0.71 | -0.10 | 1.02 | 0.09 | 1.80 |
| FCF Conversion (FCF/Net Income) | 1.17x | 1.86x | 1.83x | 1.80x | 1.51x | 1.29x | 2.46x | 2.17x | 1.79x | 2.45x | 1.96x | 2.22x | 2.37x | 2.37x | 2.60x | 1.60x | 2.56x | 2.61x | 2.67x | 1.60x | 1.78x | 2.22x | 2.45x | 1.63x | 3.30x | 1.59x | 5.30x | 1.65x | 4.07x | -4.86x | 1.74x |
| Interest Paid | 1.16B | 0 | 1.94B | 1.89B | 1.66B | 1.5B | 1.61B | 1.91B | 1.74B | 1.7B | 1.67B | 1.65B | 1.76B | 1.83B | 1.72B | 1.99B | 1.99B | 1.75B | 1.98B | 2.16B | 893M | 624M | 533M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Taxes Paid | 217M | 0 | 1.84B | 1.39B | 1.18B | 2.18B | 1B | 849M | 872M | 1.21B | 1.25B | 1.19B | 1.06B | 694M | 618M | 256M | 517M | 1.15B | 716M | 421M | 1.09B | 563M | 394M | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Working capital volatility
According to reported financial statements, HCA's operating cash flow to net income ratio fluctuated significantly, reaching a high of 2.77 in 2024Q3 before settling at 1.24 in 2026Q1, which suggests that reported earnings are frequently decoupled from the actual cash generated by core hospital operations.
The persistent gap between net income and operating cash flow indicates that non-cash adjustments and working capital swings play an outsized role in HCA's reported profitability. Investors should monitor whether this volatility stems from the timing of supplemental government payments or underlying challenges in converting service revenue into realized cash.
As indicated by recent quarterly data, HCA's free cash flow margin has experienced notable contraction, falling from a peak of 16.3% in 2025Q3 to just 4.7% in 2026Q1, reflecting a period of diminished cash generation relative to the scale of the company's revenue base.
This downward trend in FCF margins suggests that the company's ability to self-fund operations and capital requirements is currently under pressure. The inconsistency in cash flow generation may imply that the high-acuity service model is becoming increasingly sensitive to rising operational costs and reimbursement timing.
Based on HCA's reported figures, capital expenditure as a percentage of revenue has remained relatively stable, averaging between 5.4% and 7.6% over the last ten quarters, which suggests a consistent commitment to maintaining its extensive network of acute care facilities and medical infrastructure.
While this level of investment is necessary to support the cluster strategy, the lack of significant reduction in capital intensity during periods of margin pressure warrants further investigation. It appears management is prioritizing facility modernization to defend market share, even as cash flow generation becomes more erratic.
Data from recent filings reveals extreme volatility in working capital changes, ranging from a $2.3B inflow in 2025Q3 to a $1.7B outflow in 2025Q1, highlighting the significant impact of timing differences in collections and payables on the company's quarterly liquidity profile.
Such swings suggest that HCA's cash flow is highly susceptible to the timing of government reimbursement cycles and potential delays in commercial insurance settlements. This operational reality makes short-term cash flow forecasting difficult and may obscure the underlying efficiency of the company's revenue cycle management.
According to historical cash flow statements, HCA has consistently prioritized share repurchases, with quarterly buybacks frequently exceeding $2B, even during periods where free cash flow generation was significantly lower, suggesting a management preference for returning capital to shareholders over maintaining a large cash buffer.
This aggressive deployment strategy appears to rely on the assumption of stable, recurring cash flows that have not materialized consistently in recent quarters. Investors should monitor whether this pace of buybacks remains sustainable if the current trend of margin compression and working capital volatility persists.
Quick answers to the most common questions about buying HCA stock.
HCA Healthcare, Inc. (HCA) generated $12.64B in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
HCA Healthcare, Inc. (HCA) generated $7.69B in free cash flow in 2025. Free cash flow is the cash left over after capital expenditures, which can be used to pay dividends, repurchase shares, or pay down debt.
HCA Healthcare, Inc. (HCA) spent $4.94B on capital expenditures in 2025. CapEx represents the cash invested in physical assets like property, plant, and equipment to maintain or grow the business.
In 2025, HCA Healthcare, Inc. (HCA) returned $679.0M to shareholders via cash dividends and spent $10.07B on share repurchases. This shows the company's commitment to returning capital to its equity investors.