What are broad healthcare ETFs?
Healthcare ETFs own companies that develop drugs, make medical devices and lab equipment, and run health insurers and care providers. The same big names show up again and again. Of the 15 largest funds, 10 hold Thermo Fisher Scientific and 9 hold Eli Lilly and AbbVie. Johnson & Johnson, UnitedHealth Group, Merck, Gilead Sciences, Abbott Laboratories and Pfizer are each held by 8. Eli Lilly is the largest holding in each of the five biggest funds, ranging from 16.51% of XLV to 10.93% of IXJ.
Most are index funds, which track a published list of stocks, but they build those lists differently. XLV (59 stocks), IYH (100), FHLC (334) and VHT (417) weight US companies by size, and IXJ (121) does the same worldwide. RSPH gives each healthcare stock in the S&P 500 an equal share. PSCH holds small companies, PTH follows price momentum, HTEC focuses on healthcare technology and KURE owns Chinese firms. At PINK and MEDI, managers pick the stocks instead of following an index. Three funds are trading tools: CURE aims for 3x the daily return of healthcare stocks, RXL for 2x and RXD for -2x, so RXD is built to rise when they fall.
Costs vary widely. The median expense ratio (the yearly fee, taken as a share of the money invested) is 0.6% across the group, or 0.51% for funds without leverage. XLV charges the least at 0.08%, with FHLC at 0.084% and VHT at 0.09%. The highest fee, 0.95%, belongs to RXL.
Investor money is concentrated too. Of roughly $76.4 billion in these funds, 95.9% sits in the five largest: XLV, VHT, IXJ, IYH and FHLC. XLV alone holds about $40.6 billion.
Broad healthcare ETF holdings: the stocks most funds own
The stocks that show up most often among the largest positions of the 15 biggest broad healthcare ETFs with holdings reports, from their latest N-PORT filings.
| Stock | Funds holding it | Typical weight |
|---|---|---|
| Thermo Fisher Scientific Inc | 10 of 15 | 2.53% |
| Eli Lilly & Co | 9 of 15 | 12.87% |
| AbbVie Inc | 9 of 15 | 5.12% |
| Johnson & Johnson | 8 of 15 | 7.07% |
| UnitedHealth Group Inc | 8 of 15 | 4.9% |
| Merck & Co Inc | 8 of 15 | 4.12% |
| Gilead Sciences Inc | 8 of 15 | 2.34% |
| Abbott Laboratories | 8 of 15 | 2.12% |
| Pfizer Inc | 8 of 15 | 2.06% |
| Amgen Inc | 7 of 15 | 3% |
| Vertex Pharmaceuticals Inc | 7 of 15 | 1.91% |
| Bristol-Myers Squibb Co | 7 of 15 | 1.89% |
Typical weight is the median share of each fund’s assets in the stock, among the funds that hold it in their 25 largest positions.
The largest broad healthcare ETFs, side by side
Swipe the table to see all 5 funds.
| XLV | VHT | IXJ | IYH | FHLC | |
|---|---|---|---|---|---|
| Net assets | $40.60B | $22.04B | $3.84B | $3.56B | $3.29B |
| Expense ratio | 0.08% | 0.09% | 0.38% | 0.37% | 0.08% |
| Holdings | 59 | 417 | 121 | 100 | 334 |
| In the 10 largest | 61.55% | 51.66% | 47.79% | 59.03% | 51.94% |
| Biggest holding | Eli Lilly & Co (16.51%) | Eli Lilly & Co (12.87%) | Eli Lilly and Company (10.93%) | Eli Lilly and Company (15.11%) | Eli Lilly & Co (13.35%) |
| Yield | 1.38% | 1.35% | 1.33% | 1.05% | 1.17% |
| 1-year return | +30.2% | +28.9% | +19.5% | +23.8% | +23.8% |
| 3 years, a year | +16.2% | +16.9% | +13.4% | +15.0% | +16.0% |
| 5 years, a year | +8.4% | +7.3% | +6.4% | +7.1% | +7.2% |
| Worst drop, past year | -10.5% | -10.4% | -10.8% | -10.6% | -10.4% |
| Launched | 1998 | 2004 | 2001 | 2000 | 2013 |
The largest ordinary funds by net assets (leveraged and inverse funds are listed further down). Holdings from each fund’s latest N-PORT report; returns include reinvested distributions, as of Oct 30, 2026.
Head to head
XLV vs VHT
XLV owns 59 stocks and puts 61.55% of its money in the top 10, with 16.51% in Eli Lilly. VHT spreads across 417 stocks, adding many smaller companies, so its top 10 is 51.66% and Eli Lilly is 12.87%. Even so, 84.6% of their assets overlap, and fees are almost identical at 0.08% and 0.09%. In the year to October 30, 2026, XLV returned 30.2% and VHT 28.9%. Their worst drops were 10.5% and 10.4%. XLV may suit investors who want the largest companies; VHT, those who also want smaller ones.
VHT vs FHLC
VHT and FHLC are near twins. VHT holds 417 stocks; FHLC, which tracks the MSCI USA IMI Health Care 25/50 Index, holds 334. They share 96.5% of their assets, the most of any pair among the five largest funds. Both keep about half their money in the top 10 (51.66% and 51.94%), led by Eli Lilly (12.87% and 13.35%). FHLC costs 0.084% and VHT 0.09%. In the year to October 30, 2026, VHT returned 28.9% and FHLC 23.8%, and both fell as much as 10.4% at their worst. Either may suit investors wanting broad, low-cost US healthcare.
IYH vs IXJ
Both come from iShares and cost almost the same, 0.37% and 0.38%, but they cover different markets. IYH holds 100 US healthcare stocks, with 59.03% in its top 10 and 15.11% in Eli Lilly. IXJ holds 121 stocks from around the world, and its top 10 is 47.79%, with Eli Lilly at 10.93%. Their 66.4% overlap is the lowest of any pair among the five largest funds. In the year to October 30, 2026, IYH returned 23.8% and IXJ 19.5%, with worst drops of 10.6% and 10.8%. IXJ may suit investors wanting healthcare companies outside the US as well.
How much do the largest broad healthcare ETFs overlap?
Owning two funds that hold the same stocks adds little diversification. Overlap here is the share of assets two funds have in common: for each stock both own, the smaller of its two weights, added up.
| Funds | Assets in common | Shared holdings | |
|---|---|---|---|
| VHT and FHLC | 96.5% | 321 | |
| XLV and IYH | 88.9% | 54 | |
| IYH and FHLC | 87.2% | 96 | |
| VHT and IYH | 86.9% | 95 | |
| XLV and FHLC | 85% | 59 | |
| XLV and VHT | 84.6% | 59 | |
| XLV and IXJ | 70.9% | 59 | |
| VHT and IXJ | 70.9% | 63 | |
| IXJ and FHLC | 70.9% | 60 | |
| IXJ and IYH | 66.4% | 56 |
From each fund’s full holdings in its latest N-PORT report.
How have broad healthcare ETFs performed?
The five largest ordinary funds: growth from the start of the range, distributions reinvested. The dashed gray line is the S&P 500 (SPY).
Best-performing broad healthcare ETFs over the past year
| # | Fund | Net assets | Cost | 1 mo | YTD | 1 yr | 3 yr |
|---|---|---|---|---|---|---|---|
| 1 | HTEC ROBO Global Healthcare Technology and Innovation … | $69.1M | 0.68% | +1.9% | +28.0% | +36.8% | +27.4% |
| 2 | PTH Invesco Dorsey Wright Healthcare Momentum ETF | $235.2M | 0.6% | -2.2% | +21.2% | +31.0% | +28.6% |
| 3 | XLV Health Care Select Sector SPDR Fund | $40.60B | 0.08% | +9.8% | +20.9% | +30.2% | +16.2% |
| 4 | VHT Vanguard Health Care ETF | $22.04B† | 0.09% | +8.3% | +20.1% | +28.9% | +16.9% |
| 5 | RSPH Invesco S&P 500 Equal Weight Health Care ETF | $766.9M | 0.4% | +5.3% | +24.2% | +28.4% | +16.6% |
| 6 | PSCH Invesco S&P SmallCap Health Care ETF | $183.9M | 0.29% | +3.7% | +24.3% | +28.0% | +16.4% |
| 7 | FHLC Fidelity MSCI Health Care Index ETF | $3.29B | 0.08% | +4.2% | +17.0% | +23.8% | +16.0% |
| 8 | IYH iShares U.S. Healthcare ETF | $3.56B | 0.37% | +4.2% | +16.9% | +23.8% | +15.0% |
| 9 | PINK Simplify Health Care ETF | $358.6M | 0.51% | +2.5% | +9.8% | +21.1% | +20.0% |
| 10 | FXH First Trust Health Care AlphaDEX Fund | $1.05B | 0.61% | +2.7% | +19.2% | +19.7% | +15.1% |
Funds with at least $25 million in net assets; leveraged and inverse funds left out. Past returns don’t predict future returns.
How broad healthcare ETFs did in past market crashes
| Fund | 2008 crash | 2020 crash | 2022 drop |
|---|---|---|---|
| XLV | not yet launched | not yet launched | -11.6% |
| VHT | not yet launched | not yet launched | -14.5% |
| IXJ | -40.7% | -27.2% | -14.7% |
| IYH | -38.2% | -28.3% | -13.7% |
| FHLC | not yet launched | -28.7% | -14.2% |
| S&P 500 (SPY) | -55.2% | -33.7% | -24.5% |
Total return from the stock market’s peak to its low in each fall, distributions reinvested.
What drives broad healthcare ETFs?
Demand for healthcare tends to hold up when the economy slows, because people still need medicine, surgery and insurance. That is why the sector is often called defensive, meaning it has tended to fall less than the overall market in downturns. What moves individual companies is more specific: drug patents and when they expire, clinical trial results, regulatory approvals, government decisions on drug prices and on what Medicare and insurers pay, and, for insurers such as UnitedHealth Group, how fast medical costs rise. Smaller biotech companies, common in PSCH and PTH, often depend on raising money, so interest rates and investors' appetite for risk matter more to them.
Past downturns show that pattern, but the funds still lost money. In the 2008 financial crisis, IXJ fell 40.7% and IYH 38.2%, while the S&P 500 fell 55.2%. In the 2020 COVID crash, IXJ, IYH and FHLC dropped between 27.2% and 28.7%, against 33.7% for the S&P 500. In the 2022 bear market, XLV fell 11.6% and VHT 14.5%, compared with 24.5% for the S&P 500. Losing less than the market still meant real losses, especially in 2008.
Broad healthcare ETFs with the lowest expense ratios
| # | Fund | Expense ratio | On $10,000 | Net assets |
|---|---|---|---|---|
| 1 | XLV Health Care Select Sector SPDR Fund | 0.08% | $8 a year | $40.60B |
| 2 | FHLC Fidelity MSCI Health Care Index ETF | 0.08% | $8 a year | $3.29B |
| 3 | VHT Vanguard Health Care ETF | 0.09% | $9 a year | $22.04B |
| 4 | PSCH Invesco S&P SmallCap Health Care ETF | 0.29% | $29 a year | $183.9M |
| 5 | IYH iShares U.S. Healthcare ETF | 0.37% | $37 a year | $3.56B |
Ordinary funds with at least $10 million in net assets. The median ordinary broad healthcare ETF charges 0.51% a year; leveraged and inverse funds usually charge more.
Do broad healthcare ETFs pay dividends?
16 of the 17 ordinary broad healthcare ETFs with a page here paid distributions over the last 12 months, with a median yield of 0.99%.
| Highest yields | Yield | Net assets |
|---|---|---|
| KURE KraneShares MSCI All China Health Care Index … | 4.02% | $71.2M |
| PTH Invesco Dorsey Wright Healthcare Momentum ETF | 2.54% | $235.2M |
| XLV Health Care Select Sector SPDR Fund | 1.38% | $40.60B |
| VHT Vanguard Health Care ETF | 1.35% | $22.04B |
| IXJ iShares Global Healthcare ETF | 1.33% | $3.84B |
Distributions over the last 12 months divided by the price; funds with at least $25 million in net assets.
How to choose a broad healthcare ETF
- Fees range from 0.08% to 0.95%. XLV (0.08%), FHLC (0.084%) and VHT (0.09%) are the cheapest. Next come PSCH at 0.29% and IYH at 0.37%. Specialist funds such as FXH (0.61%) and HTEC (0.68%) charge several times more for a different approach.
- How much rides on a few stocks. XLV puts 61.55% in its top 10 holdings, including 16.51% in Eli Lilly, and MEDI puts 20.78% in Eli Lilly alone. RSPH and FXH spread money more evenly, with 19.44% and 24.63% in their top 10.
- By size, equally, or by judgment. XLV, VHT and FHLC weight stocks by company size. RSPH gives each stock an equal share. PTH picks by price momentum, PSCH sticks to small companies, and PINK and MEDI rely on managers' judgment.
- US-only or worldwide. Most funds hold mainly US companies. IXJ adds healthcare firms worldwide, and KURE owns Chinese companies such as BeOne Medicines and Innovent Biologics. In the year to October 30, 2026, KURE lost 5.7% while XLV gained 30.2%.
- Fund size affects trading. XLV holds about $40.6 billion and VHT about $22 billion. MEDI has about $41 million and HTEC about $69 million. Very small funds can cost more to trade and are more likely to close.
- Leveraged and inverse funds are trading tools. CURE aims for 3x and RXL for 2x the daily move of healthcare stocks; RXD aims for -2x. Because they reset daily, returns over months can stray far from those multiples, in either direction.
What are the risks of broad healthcare ETFs?
- Heavy reliance on Eli Lilly. Eli Lilly makes up 16.51% of XLV and 20.78% of MEDI, and XLV's top 10 holdings total 61.55%. Bad news for one company or one major drug can move the whole fund.
- Owning several funds adds little variety. Thermo Fisher, Eli Lilly, AbbVie and Johnson & Johnson each appear in 8 to 10 of the 15 largest funds. XLV and IYH share 88.9% of their assets, and VHT and FHLC 96.5%.
- Drug prices and payment rules. Government decisions on drug prices, approvals and what Medicare and insurers pay can hit many holdings at once. Insurers such as UnitedHealth Group, held by 8 of the 15 largest funds, earn less when medical costs climb.
- Specialist funds swing harder. As of October 30, 2026, XLV's one-year volatility (how widely its returns swung) was 16.4%, and its worst drop was 10.5%. PTH's volatility was 26.5%, and KURE fell as much as 24.4%.
- Leveraged funds can magnify losses. In the year to October 30, 2026, CURE fell as much as 31.1% and RXL 21.4% at their worst. Daily resets make losses compound in choppy markets, and the inverse RXD lost 34.6% over the year.
Leveraged and inverse broad healthcare ETFs (2x and 3x)
These funds aim for a multiple, or the opposite, of one day’s return, and reset every day. Held for longer than a day, their results can drift far from that multiple, especially when prices swing. They are trading tools, not long-term holdings. Why leveraged ETFs decay →
List of all broad healthcare ETFs, by size
| # | Fund | Net assets | Cost | Yield | YTD | 1 yr | 5 yr |
|---|---|---|---|---|---|---|---|
| 1 | XLV Health Care Select Sector SPDR Fund | $40.60B | 0.08% | 1.38% | +20.9% | +30.2% | +8.4% |
| 2 | VHT Vanguard Health Care ETF | $22.04B† | 0.09% | 1.35% | +20.1% | +28.9% | +7.3% |
| 3 | IXJ iShares Global Healthcare ETF | $3.84B | 0.38% | 1.33% | +13.2% | +19.5% | +6.4% |
| 4 | IYH iShares U.S. Healthcare ETF | $3.56B | 0.37% | 1.05% | +16.9% | +23.8% | +7.1% |
| 5 | FHLC Fidelity MSCI Health Care Index ETF | $3.29B | 0.08% | 1.17% | +17.0% | +23.8% | +7.2% |
| 6 | FXH First Trust Health Care AlphaDEX Fund | $1.05B | 0.61% | 0.55% | +19.2% | +19.7% | +3.1% |
| 7 | RSPH Invesco S&P 500 Equal Weight Health Care ETF | $766.9M | 0.4% | 0.56% | +24.2% | +28.4% | — |
| 8 | PINK Simplify Health Care ETF | $358.6M | 0.51% | 0.75% | +9.8% | +21.1% | +9.8% |
| 9 | PTH Invesco Dorsey Wright Healthcare Momentum ETF | $235.2M | 0.6% | 2.54% | +21.2% | +31.0% | +3.1% |
| 10 | PSCH Invesco S&P SmallCap Health Care ETF | $183.9M | 0.29% | 0% | +24.3% | +28.0% | -1.1% |
Questions investors ask about broad healthcare ETFs
What is the largest healthcare ETF?
XLV, the Health Care Select Sector SPDR Fund from State Street, is the largest, with about $40.6 billion in assets. Vanguard's VHT is second at about $22 billion. iShares' IXJ and IYH and Fidelity's FHLC follow, with roughly $3.3 billion to $3.8 billion each. Together, these five hold 95.9% of the money in broad healthcare ETFs.
Which healthcare ETF has the lowest expense ratio?
XLV has the lowest expense ratio, at 0.08% a year. Fidelity's FHLC is close behind at 0.084%, followed by Vanguard's VHT at 0.09%. All three weight stocks by company size, so they lean on Eli Lilly and other giants. The next cheapest is PSCH at 0.29%, which holds small healthcare companies instead. RXL, a 2x leveraged fund, has the highest fee in the group at 0.95%.
XLV vs VHT: what's the difference?
Mainly breadth. XLV holds 59 stocks and puts 16.51% in Eli Lilly. VHT holds 417, including many smaller companies, and puts 12.87% in Eli Lilly. They share 84.6% of their assets and charge 0.08% and 0.09%. In the year to October 30, 2026, XLV returned 30.2% and VHT 28.9%. Over five years they returned 8.4% and 7.3% a year. VHT may suit investors who want smaller companies alongside the giants.
Do healthcare ETFs pay dividends?
Yes, nearly all do: 16 of the 17 funds with dividend data paid dividends, with a median yield of 0.99%. As of October 30, 2026, KURE had the highest yield at 4.02%, followed by PTH at 2.54%. The big funds paid less: XLV yielded 1.38%, VHT 1.35% and IXJ 1.33%. With yields mostly near 1%, income is a small part of these funds' total return.
Do healthcare ETFs hold Eli Lilly?
Most of the large ones do. Eli Lilly is held by 9 of the 15 largest healthcare ETFs. It is the biggest holding in XLV (16.51%), IYH (15.11%), FHLC (13.35%), VHT (12.87%) and IXJ (10.93%). Harbor's actively managed MEDI puts 20.78% in it. Funds that weight differently give it far less room: in equal-weight RSPH, the largest holding, Bio-Techne, is just 2.13%.
How many healthcare ETFs are there?
This guide counts 20 US-listed broad healthcare ETFs. Three are leveraged or inverse: CURE, RXL and RXD. The rest range from giant index funds such as XLV and VHT to small specialist funds. These include HTEC, which focuses on healthcare technology, and KURE, which owns Chinese healthcare stocks. PINK and MEDI are run by managers who pick stocks rather than track an index.
What are leveraged healthcare ETFs like CURE?
CURE and RXL are leveraged ETFs: CURE aims for 3x the daily return of its healthcare index and RXL for 2x. RXD is inverse, aiming for -2x, so it gains when healthcare stocks fall. They reset every day, so over weeks or months their results can drift far from those multiples, especially when prices swing. In the year to October 30, 2026, CURE returned 61.4% but at one point was down 31.1%, and RXD lost 34.6%. They are built for short-term trading.
Is there a Vanguard or Fidelity healthcare ETF?
Yes. Vanguard Health Care ETF (VHT) holds 417 stocks and costs 0.09%. Fidelity MSCI Health Care Index ETF (FHLC) tracks the MSCI USA IMI Health Care 25/50 Index, holds 334 stocks and costs 0.084%. The two share 96.5% of their assets, so they own almost the same companies in similar amounts. In the year to October 30, 2026, VHT returned 28.9% and FHLC 23.8%.
Is there a Vanguard, Fidelity or Schwab healthcare ETF?
Yes. Vanguard offers one: VHT (Vanguard Health Care ETF). Fidelity offers one: FHLC (Fidelity MSCI Health Care Index ETF). Schwab doesn’t have a healthcare ETF.
