XHS vs XLV: Grades, Fees and Holdings Compared

State Street SPDR S&P Health Care Services ETF

XHSANYSE Arca

State Street Health Care Select Sector SPDR ETF

XLVANYSE Arca

Overlap

13.0%by weight

Expense ratio

XLV −0.27pt a year

XHS0.35%XLV0.08%

Avg volume · 30D

XLV 285.1×the volume

XHS31.9KXLV9.1M

10Y return · a year

XLV +1.0pt

XHS+11.5%XLV+12.5%

XHS vs XLV Performance

Oct 29, 2021 – Oct 30, 2026

+36.6%XHS+49.8%XLV

Expense ratio: XHS 0.35%; XLV 0.08%, better
Fund size: XHS $234M; XLV $48.5B
1Y total return: XHS +39.7%, better; XLV +30.3%
Yield (12M): XHS 0.15%; XLV 1.38%, better
Holdings: XHS 63; XLV 64
Avg volume (30D): XHS 31.9K sh; XLV 9.1M sh, better
NAV per share: XHS $144.25; XLV $184.09
52W range

ETF.net Grade

Pillar letters and Scores for XHS, XLV, with each pillar’s weight
Pillar	XHS	XLV
Cost30% weight	A81	A98Higher
Mission25% weight	Not scored	A84
Risk15% weight	A78	A78
Tradability15% weight	C54	A100Higher
Holdings10% weight	A87Higher	D39
Durability5% weight	B64	A87Higher

Rank among Health Care (Broad) funds

How we build Categories ›

Same Category. XHS and XLV are both graded against the same 25 Health Care (Broad) funds, so their Grades compare head to head.

Health Care (Broad)⁠

Category · 25 funds

See all 25 ›

XLV ranks 1st and XHS 4th of 25 funds in the Health Care (Broad) Category.

Rank 1AXLVState Street Health Care Select Sector SPDR ETFScore 85
Rank 2AFHLCFidelity MSCI Health Care Index ETFScore 83
Rank 3AVHTVanguard Health Care ETFScore 77
Rank 4AXHSState Street SPDR S&P Health Care Services ETFScore 74
Rank 5AIYHiShares U.S. Healthcare ETFScore 71

Our read on each fund

ETF.net Research

XHSAState Street SPDR S&P Health Care Services ETF

XLVAState Street Health Care Select Sector SPDR ETF

In short

XHS Most health care ETFs are pharma funds in disguise. XHS buys the delivery system instead: insurers, hospitals, distributors and clinics, roughly equal weighted so one giant insurer does not run the show.

XLV Live since 1998, XLV is the original way to own health care: about 60 S&P 500 names, a 0.08% fee, and one of the busiest tickers in the sector. Big pharma and device makers, not small-cap biotech.

Stated mandate

XHS The fund seeks to track the total return of the S&P Health Care Services Select Industry Index before fees and expenses, providing targeted exposure to health care services companies.

XLV The fund seeks to track, before expenses, the price and yield performance of the Health Care Select Sector Index, which represents the health care sector of the S&P 500 Index.

Why people hold it

XHS No drugmakers, no device makers. The index tracks four slices of care delivery: distributors, facilities, health care services and managed care.ssga.com
Modified equal weighting spreads about 60 names across large, mid and small caps, so the portfolio is not a bet on two or three mega caps.ssga.com
0.35% a year sits below the 0.50% median for broad health care ETFs, on a fund that has been running since 2011.
Ranks in the top quartile of the broad health care ETFs we grade.

XLV 0.08% a year against a cohort median of 0.50%. That ties it with FHLC as the cheapest in the group and edges VHT at 0.09%.
One of the most actively traded funds in its category, which generally keeps bid-ask spreads thin whether you trade 10 shares or 10,000.
Launched December 1998 as one of the first US sector funds, and it has tracked its S&P 500 health care index closely ever since.
Covers the whole sector in one line: pharma, devices, providers, biotech, life-science tools and health tech. Pays quarterly.ssga.com

Worth knowing

XHS Cheap against the median, not against the giants: XLV, VHT and FHLC charge under a tenth of a percent for cap weighted whole sector exposure.
Thinly traded next to the big sector funds, so spreads and limit orders matter more here.
Leaving out pharma and biotech means it moves differently from a whole sector fund, and insurers and hospitals sit close to reimbursement policy.ssga.com

XLV Cap-weighted and about 60 names deep, so the largest drug and device makers carry most of the weight.ssga.com
S&P 500 members only. Mid- and small-cap health care names sit outside the mandate.
One sector, one set of headlines: drug pricing rules, patent expirations and policy shifts move the whole basket together.

Full XHS profile⁠

Full XLV profile⁠

XHS vs XLV Holdings

How XHS and XLV differ

Overlap by weight

13.0%

Shared holdings make up 26.1% of XHS and 17.1% of XLV.

Level by level

Holdings15 in both13.0%
Sector3 Sectors98.1%
Asset classEquity100%
Countryby domicile100%

Sector

Sector weights in XHS and XLV, widest gap first
Sector	More in XHSMore in XLV	XHS	XLV
Financials	XHS +1.9 points	1.9%	0.0%
Health Care	XLV +1.2 points	98.1%	99.3%
Technology	XLV +0.7 points	0.0%	0.7%

Country, concentration and asset class

Country by domicile

Country weights in XHS and XLV, widest gap first
Country	More in XHSMore in XLV	XHS	XLV
United States	Same weight	100.0%	100.0%

Concentration

Weight in the 10 largest Holdings

XHS20.7%
XLV61.0%

Securities held

XHS61
XLV62

Asset class

XHS: Equity
XLV: Equity

Holdings

Only in XHS46
In both15
Only in XLV47

Only in XHS

46 securities, 73.9% of XHS by weight

Surgery Partners Inc2.71%
Amn Healthcare Services Inc2.25%
Option Care Health Inc2.22%
Hinge Health Inc A2.11%
Concentra Group Holdings Par1.98%
Corvel Corp1.93%
Billiontoone Inc Class A1.90%
Guardant Health Inc1.87%
Pacs Group Inc1.83%
U.s. Physical Therapy Inc1.83%
Healthequity Inc1.80%
Ensign Group Inc/The1.78%
Encompass Health Corp1.78%
Lifestance Health Group Inc1.78%
Pediatrix Medical Group Inc1.77%
Privia Health Group Inc1.77%
Hims & Hers Health Inc1.75%
Nutex Health Inc1.75%
Clover Health Investments Co1.74%
Progyny Inc1.72%
Acadia Healthcare Co Inc1.72%
Chemed Corp1.72%
Addus Homecare Corp1.72%
Radnet Inc1.71%
Molina Healthcare Inc1.69%
Neogenomics Inc1.67%
Tenet Healthcare Corp1.65%
Brightspring Health Services1.60%
Astrana Health Inc1.58%
Aveanna Healthcare Holdings1.56%
National Healthcare Corp1.54%
Guardian Phrmcy Services A1.53%
Agilon Health Inc1.51%
Omada Health Inc1.50%
Castle Biosciences Inc1.42%
Sonida Senior Living Inc1.42%
Brookdale Senior Living Inc1.39%
Pennant Group Inc/The1.39%
Genedx Holdings Corp1.35%
Adapthealth Corp1.32%
Starling Oncology Inc1.18%
Alignment Healthcare Inc1.02%
Fulgent Genetics Inc0.75%
Strata Critical Medical Inc0.72%
Opko Health Inc0.54%
Community Health Systems Inc0.43%

Only in XLV

47 securities, 82.9% of XLV by weight

Eli Lilly & Co16.46%
Johnson & Johnson9.93%
AbbVie Inc7.70%
Merck & Co. Inc.5.41%
Thermo Fisher Scientific Inc3.93%
Amgen Inc3.73%
Gilead Sciences Inc3.08%
Abbott Laboratories2.71%
Pfizer Inc2.56%
Intuitive Surgical Inc2.37%
Danaher Corp2.22%
Vertex Pharmaceuticals Inc2.05%
Bristol Myers Squibb Co1.88%
Medtronic PLC1.78%
Stryker Corp1.63%
Moderna Inc1.24%
Regeneron Pharmaceuticals1.20%
Boston Scientific Corp0.93%
Edwards Lifesciences Corp0.82%
Becton Dickinson and Co0.81%
Agilent Technologies Inc0.77%
Waters Corp0.71%
Veeva Systems Inc Class A0.69%
Idexx Laboratories Inc0.68%
Iqvia Holdings Inc0.68%
Illumina Inc0.66%
Biogen Inc0.55%
Resmed Inc0.55%
Ge Healthcare Technology0.52%
Mettler Toledo International0.52%
Zoetis Inc0.48%
Dexcom Inc0.45%
West Pharmaceutical Services0.44%
Steris PLC0.34%
Viatris Inc0.33%
Incyte Corp0.30%
Zimmer Biomet Holdings Inc0.28%
Revvity Inc0.28%
Charles River Laboratories0.27%
Baxter International Inc0.18%
Solventum Corp0.18%
Cooper Cos Inc/The0.18%
Bio Techne Corp0.17%
Insulet Corp0.16%
Align Technology Inc0.15%
Xav Health Care DEC260.02%
Contra Hologic Incorpo0.00%

Weight gaps

All 15 Holdings in both funds, largest gap first.

Holding weights in XHS and XLV, widest gap first
Holding	More in XHSMore in XLV	XHS	XLV
UnitedHealth Group IncUNH	XLV +3.80 points	1.72%	5.52%
Davita IncDVA	XHS +1.64 points	1.74%	0.10%
Universal Health Services BUHS	XHS +1.51 points	1.65%	0.14%
Henry Schein IncHSIC	XHS +1.50 points	1.62%	0.12%
Labcorp Holdings IncLH	XHS +1.44 points	1.89%	0.45%
Quest Diagnostics IncDGX	XHS +1.35 points	1.77%	0.42%
Centene CorpCNC	XHS +1.25 points	1.76%	0.51%
Humana IncHUM	XHS +0.96 points	1.71%	0.75%
Cardinal Health IncCAH	XHS +0.85 points	1.72%	0.87%
Hca Healthcare IncHCA	XHS +0.81 points	1.86%	1.05%
Cencora IncCOR	XHS +0.74 points	1.68%	0.94%
The Cigna GroupCI	XHS +0.58 points	1.76%	1.18%
Elevance Health IncELV	XHS +0.38 points	1.75%	1.37%
Cvs Health CorpCVS	XLV +0.17 points	1.56%	1.73%
Mckesson CorpMCK	XHS +0.10 points	1.81%	1.71%

All 61 XHS holdings⁠All 61 XLV holdings⁠

How we measure overlap

Each holding counts at its smaller weight in the two funds, summed over the full Holdings. Sector, country and asset class use the same rule on each fund’s split. Cash, FX and derivative lines stay out of the counts. Two bond funds get no overlap figure.

XHS vs XLV Cost

Overpaying XHS vs XLV

$5,437

On $10,000 over 30 years. 7% growth a year before fees, expense ratio only.

XHS 0.35%
$7,126
XLV 0.08%
$1,689

Amount$10,000

Years30 years

Cost over time

XHS 0.35%
XLV 0.08%
Overpaying

Year by year

Year	XHS	XLV	Overpaying
10	$634	$147	$487
20	$2,454	$575	$1,879
30	$7,126	$1,689	$5,437

Expense ratio

0.35%XHS
0.08%XLV, cheaper

XLV0.08%XHS0.35%

0.08%0.85%

Middle half of Health Care (Broad) funds
Median 0.50%

XLV cheapest of 25 funds

XHS 5th cheapest of 25 funds

XHS vs XLV Dividends

Last 12 months to Oct 30, 2026

Yield (12M): XHS 0.15%; XLV 1.38%, better
Payout (12M): XHS $0.21; XLV $2.55
Last payment: XHS $0.01; XLV $0.64
Ex-dividend: XHS Sep 21, 2026; XLV Sep 21, 2026
Paid on: XHS Sep 23, 2026; XLV Sep 23, 2026
Frequency: XHS Quarterly; XLV Quarterly

Distribution history

Per share, 2017 to 2026, same scale for both

XHSQuarterly · 39 paymentsAll XHS payments⁠

XLVQuarterly · 40 paymentsAll XLV payments⁠

XHS vs XLV Risk

Fall from peak · 5 years

Risk facts

VolatilityStd dev, 3 years: XHS 20.8%XLV 14.8%, better
Return per unit of riskSharpe ratio, 3 years: XHS 0.85, betterXLV 0.78
Worst fallMax drawdown, 5 years: XHS −30.0%XLV −17.1%, better
Market sensitivityBeta, 5 years: XHS 0.93XLV 0.56; Market = 1

XHS and XLV in the news

All news⁠

Deep Dive
Health care's 1.8% week was four large caps, not a biotech rally
Sep 19, 2026XHSXLV
Deep Dive
Health care ETFs spent 2026 between a 28% biotech rally and a 16% device slide
Sep 14, 2026XHSXLV
The Big Picture
Two-year Treasury yield fell 11 basis points alongside the AI share selloff
Oct 31, 2026XLV
Top Movers
Alphabet fell 12.6%, but the average stock rose
Oct 29, 2026XLV
Closing Bell
Alphabet falls 12.6% - dragging SPY into negative territory for the day
Oct 29, 2026XLV
Deep Dive
Moderna fell 18% on cancer-vaccine data, and genomics ETFs fell 4%
Oct 23, 2026XLV

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