American Healthcare REIT (AHR) Q3 2025: Same-Store NOI Jumps 16.4% as RIDEA Segments Hit 90% Occupancy

November 7, 2025 | By EarningsIQ Research

American Healthcare REIT’s third quarter delivered another round of double-digit same-store NOI growth, powered by disciplined expansion in its RIDEA segments and robust occupancy gains. Strategic alignment with regional operators and a sharpened capital deployment focus are extending AHR’s multi-year growth runway, with forward guidance raised across all major performance metrics. Investors should watch for continued margin expansion and the pace of pipeline conversion as AHR enters 2026 with record growth momentum.

Summary

• RIDEA Segments Drive Outperformance: Integrated senior health campuses and SHOP segments both delivered outsized NOI growth and occupancy above 90%.
• Pipeline and Portfolio Optimization Accelerate: Over $575 million in acquisitions year-to-date and a $450 million awarded deal pipeline position AHR for further scale.
• Guidance Raised on Visibility: Upward revision in full-year growth targets signals confidence in continued sector tailwinds and disciplined capital allocation.

Performance Analysis

AHR’s Q3 results underscore a business firing on all cylinders, with same-store net operating income (NOI) up 16.4% across the portfolio—marking the seventh consecutive quarter of double-digit same-store NOI growth. The RIDEA, or “REIT Investment Diversification and Empowerment Act,” segments—which include integrated senior health campuses (Trilogy) and SHOP (Senior Housing Operating Portfolio)—were the primary engines, both now maintaining same-store occupancies above 90% and showing continued positive trends.

Trilogy’s same-store NOI surged 21.7% YoY, with average daily rates up 7% and quality mix improvements driving both pricing power and higher Medicare Advantage penetration. SHOP NOI rose 25.3% YoY, with margin expansion of nearly 300 basis points to 21.5%. Outpatient medical and triple net lease segments also contributed, though at a more modest pace. Normalized funds from operations (NFFO) per share increased 22% YoY, reflecting both organic growth and accretive acquisitions.

• Occupancy Gains Cement Leverage: SHOP and Trilogy segments both surpassed the critical 90% occupancy threshold, unlocking further operating leverage and pricing flexibility.
• Acquisition and Development Activity Remain Elevated: Year-to-date closed acquisitions exceeded $575 million, with a robust pipeline of $450 million in awarded deals and $177 million in active development projects.
• Balance Sheet Strengthens Amid Growth: Net debt to EBITDA improved to 3.5x, down 1.6x YoY, supporting further disciplined expansion.

Overall, the quarter demonstrates AHR’s ability to capture secular demand tailwinds while maintaining operational and financial discipline. The company’s tight focus on quality operators, asset mix, and capital structure is translating into durable earnings growth and increased guidance for the remainder of the year.

Executive Commentary

Strategic Positioning

1. RIDEA Segment Leadership and Operator Alignment

AHR’s operating model leverages RIDEA structures, which allow for direct participation in property-level cash flows and upside from operational improvements. The company’s focus on partnering with best-in-class regional operators—particularly through Trilogy and SHOP—enables both high occupancy and pricing discipline. Alignment is further deepened by unique incentive structures, such as manager equity plans that tie operator compensation to AHR stock performance.

2. Pipeline Depth and Disciplined Growth

The external growth engine is robust, with over $575 million in acquisitions closed year-to-date and a $450 million awarded deal pipeline expected to close by early 2026. New operator relationships, such as WellQuest Living and Great Lakes Management, are expanding geographic reach and providing access to off-market deals, reinforcing AHR’s relationship-driven sourcing strategy.

3. Quality Mix Optimization and Margin Expansion

Trilogy’s proactive shift toward higher-acuity, higher-reimbursement residents—particularly through Medicare Advantage— is driving both revenue growth and margin improvement. Medicare Advantage now accounts for 7.2% of Trilogy resident days, up from 5.8% YoY, with management expecting this mix shift to continue supporting robust top-line and margin gains.

4. Capital Allocation and Balance Sheet Discipline

Capital deployment is tightly matched to investment timing, with $116 million raised through the ATM program and $128 million from a forward sale, plus new forward agreements for $275 million. Net debt to EBITDA improved to 3.5x, supporting further accretive investments without overleveraging the balance sheet.

5. Technology and Platform Leverage

AHR is piloting the extension of Trilogy’s centralized revenue management and analytics systems to other operators, aiming to replicate best practices in pricing, occupancy management, and operational efficiency. While currently in early phases, this initiative is positioned as a future differentiator, especially as regional operators seek to scale with AHR’s support.

Key Considerations

This quarter marks a critical inflection point for AHR, as the company consolidates its leadership in high-acuity senior housing and positions itself for sustainable, multi-year growth. Investors should focus on the company’s ability to maintain margin expansion, convert its pipeline, and further leverage its operator platform.

Key Considerations:

• Operating Leverage at High Occupancy: SHOP and Trilogy’s move above 90% occupancy unlocks additional pricing and margin upside, with further gains possible as demand accelerates.
• Pipeline Execution and Integration: The $450 million awarded deal pipeline and new operator relationships will test AHR’s ability to integrate and scale efficiently.
• Quality Mix and Payer Strategy: Ongoing optimization toward Medicare Advantage and higher-acuity residents is critical for sustaining NOI and margin growth, especially as reimbursement trends evolve.
• Capital Markets Discipline: Matching equity inflows to investment timing minimizes dilution and preserves balance sheet flexibility, but requires careful pacing as acquisition activity remains high.
• Technology Platform Rollout: The success of extending Trilogy’s revenue management system to other operators could become a key competitive advantage if adoption accelerates.

Risks

Key risks include potential margin compression from labor or inflation shocks, especially during winter months when expenses typically rise. Medicare rate increases are moderating, which may temper revenue growth in the skilled segment. Integration risk exists as the company onboards new operator partners and rolls out platform technologies. Additionally, competitive pressures for high-quality senior housing assets could impact acquisition yields if asset pricing rises faster than rental growth.

Forward Outlook

For Q4 2025, AHR guided to:

• Continued same-store NOI growth across RIDEA segments, with occupancy expected to remain above 90%.
• Pipeline conversion of $450 million in awarded deals, closing by early 2026.

For full-year 2025, management raised guidance:

• NFFO per share to $1.69–$1.72 (from $1.64–$1.68), reflecting 20%+ YoY growth.
• Same-store NOI growth to 13–15% (from 11–14%), with segment-level increases across integrated senior health campuses, SHOP, and outpatient medical.

Management highlighted several factors that underpin the outlook:

• Visibility into Q4 occupancy and margin trends supports confidence in beating prior targets.
• Sustained demographic tailwinds and muted new supply are expected to drive further occupancy and rate growth into 2026.

Takeaways

AHR’s strategic discipline and operational alignment are translating to sector-leading growth, with momentum likely to carry into 2026 given the robust pipeline and demographic tailwinds.

• Secular Demand Tailwinds: Aging population and low construction starts create a favorable environment for occupancy and rate growth in senior housing.
• Platform Leverage Opportunity: The rollout of Trilogy’s systems to regional operators could unlock incremental value and operational consistency.
• Watch Pipeline Conversion: Timely closing and integration of awarded deals will be key to sustaining earnings momentum and validating the external growth thesis.

Conclusion

AHR’s Q3 2025 performance cements its role as a leader in high-acuity senior housing, combining disciplined capital allocation with operational excellence. With robust organic growth, a deep acquisition pipeline, and a clear path to further margin expansion, AHR is positioned to deliver durable returns as sector fundamentals remain strong.

Industry Read-Through

AHR’s results reinforce the accelerating demand for senior housing, especially for operators with scale, quality outcomes, and strong regional presence. The muted new supply and demographic surge in the 80-plus cohort are likely to support occupancy and pricing across the sector for years. Other healthcare REITs and private equity players may face increasing competition for stabilized, high-quality assets as performance improves industry-wide, but disciplined operator alignment and platform leverage will be key differentiators. Investors should monitor the sector for continued consolidation and innovation in operator partnerships and technology adoption.

AHR Real Estate Healthcare REIT Senior Housing RIDEA Occupancy Pipeline Medicare Advantage