Irvine, Calif. — American Healthcare REIT wrapped up 2025 on a high note, posting fourth-quarter net income of $10.9 million — a sharp reversal from the $32.4 million net loss the company reported in the same period a year earlier. The turnaround, executives said, was driven largely by its Trilogy Health Services portfolio, which outpaced national benchmarks on nearly every major financial metric.
The publicly traded real estate investment trust, which operates skilled nursing and senior living communities across the country, said normalized funds from operations for Q4 reached $82.8 million, or $0.46 per share, up from $62.4 million in the fourth quarter of 2024. For the full year, same-store net operating income at Trilogy facilities climbed 18.4% compared to 2024.
Trilogy’s Medicare Advantage edge
A key factor in Trilogy’s outperformance: Medicare Advantage rate negotiations. The chain secured rate growth of 5.2% — well above the roughly 3% national average — by leaning into high-acuity admissions and building stronger relationships with MA insurers. COO Gabe Willhite said 2025 was a “tremendous” year for renegotiating MA contracts, and that the length-of-stay pressures that have dogged operators across the industry are starting to ease.
“We’re not going to sacrifice rate for occupancy, and we’re not going to sacrifice occupancy for rate,” Willhite said during the company’s quarterly earnings call.
Trilogy’s occupancy hit 90.6% in the fourth quarter, with the payer mix shifting toward Medicare and Medicare Advantage and away from Medicaid — a trend executives expect to continue.
Growth through campus expansion
Beyond rate negotiations, Trilogy is expanding its physical footprint with new “Villa” projects — additions to existing campuses that push into assisted living and private-pay services. The goal, Willhite said, is to diversify revenue and accelerate cash flow that can be recycled back into new development.
Chief Investment Officer Stefan Oh said the team closed more than $950 million in acquisitions in 2025, mostly in seniors housing, with an additional $117.5 million in deals closing earlier this year and about $230 million more in the pipeline. Going forward, the company is targeting newer, high-acuity assets in markets with strong demographic tailwinds. About half of recent deals were sourced directly through operator relationships, bypassing the open market.
“Trilogy is unique in the space,” Willhite said. “They’ve got the mix of skilled nursing, assisted living, independent living and memory care all under one roof — and that creates different drivers for their NOI growth.”
Looking ahead, the company said greater clarity on MA contract adjustments and the CMS Medicare rate announcement expected in April will help shape performance projections for the rest of 2026. For now, the numbers are telling a story of a portfolio that’s found its footing — and isn’t done growing.
