XLV vs VHT vs IYH: Healthcare ETF Holdings, Overlap and Basket Analysis

This comparison answers how the three funds define their eligible companies, limit concentration and report their holdings. It is not a past-performance ranking or a buy recommendation. A healthcare label alone does not make two funds interchangeable: index universe, classification system, weighting rules, portfolio date and fees all matter.

XLV tracks the Health Care Select Sector Index, which draws healthcare companies from the S&P 500 using GICS sector classification. That makes it a large-cap slice of the U.S. market, not a portfolio of every U.S. healthcare company. The index uses market-cap weighting with concentration controls. S&P’s Select Sector capping update describes a 23% single-company limit when a name exceeds 24%, plus a 50% aggregate ceiling for names above 4.8%, followed by quarterly reweighting. See the State Street XLV profile, the S&P index page and the S&P capping update.

VHT follows the MSCI US Investable Market Health Care 25/50 Index. It uses GICS and reaches across U.S. large-, mid- and small-cap healthcare stocks. The 25/50 name refers to issuer constraints: no issuer above 25%, and issuers individually above 5% together no more than 50%. Those are index caps, not equal-weight instructions or a promise that each fund position stays at a fixed weight. See Vanguard’s VHT page, the MSCI index profile and the MSCI 25/50 methodology.

IYH’s current benchmark is the Russell 1000 Health Care RIC 22.5/45 Capped Index. It takes healthcare companies from the Russell 1000 under ICB classification, which is not identical to the GICS categories used by XLV and VHT. Its RIC rules cap an individual issuer at 22.5% and the combined weight of issuers above 4.5% at 45%. This is a different index universe and capping framework, not simply the same healthcare list under another ticker. See the iShares IYH profile, FTSE Russell’s capped-index page, its capping guide and the August 2026 SEC summary prospectus.

As of September 26, 2026, the newest Form N-PORT periods located for the funds were June 30 for XLV, May 31 for VHT and July 31 for IYH. The primary SEC filings are XLV, Vanguard Health Care Index Fund and IYH. Their filing calendars are not synchronized, so the holdings cannot be treated as one same-day portfolio comparison.

We extracted common-stock position rows and SEC-reported portfolio weights (pctVal). The filings contained 59 XLV stock rows, 402 VHT stock rows and 100 IYH stock rows. Those rows represented 99.681953%, 99.800165% and 99.750131% of net assets, respectively. These are stock rows in the reported N-PORT series, not necessarily the issuer website’s current total holding count; cash, derivatives and other asset types are outside that stock-row count. VHT’s filing is for the Vanguard Health Care Index Fund series, so it informs the underlying share-class portfolio rather than a separate account-level portfolio for the ETF share class alone.

Between those report dates, prices, shares, index membership and net-asset denominators may have changed. We therefore show each report’s top holdings with its own date and do not merge the three files into a same-day overlap calculation.

The table ranks positions within each separate SEC snapshot. Percentages are the filing’s market values relative to net assets; top-ten sums use the unrounded source weights and are then rounded to two decimals.

Large pharmaceutical, care-services and medical-technology companies appear near the top in all three snapshots. Similar names indicate common large-company exposure, but the table alone does not establish equal share counts or weights. The funds’ own top-ten totals use different dates and net-asset denominators. Repeated names are an observation, not a complete holdings-overlap statistic.

The following are issuer-published industry allocations, each with its own date. XLV and VHT use GICS categories; IYH uses ICB. Similar English labels may not represent identical classification definitions, so these rows show each fund’s profile rather than a synchronized sector decomposition.

The two September 24 profiles and VHT’s July 31 profile are asynchronous. All show meaningful pharmaceutical and biotechnology exposure, but a 37.33% GICS line and a 37.05% ICB line should not be presented as a precise like-for-like difference. The source profiles are SSGA XLV, Vanguard VHT and iShares IYH.

The reported top-ten totals are 61.55% for XLV, 51.88% for VHT and 59.03% for IYH. On these snapshots, XLV’s top ten represented the largest share, while VHT’s represented the smallest; VHT also had the broadest number of reported stock rows. That pattern is consistent with VHT’s large-, mid- and small-cap universe, but it is not a permanent ranking. Prices, index changes, cash balances, fund activity and report dates can all affect a snapshot.

Do not use holding count as a substitute for concentration. A fund with hundreds of stocks can still depend heavily on a few large companies. A smaller basket can apply formal issuer caps. Review stock-row count, top-ten total, largest single-company weights and industry composition together. A 25/50 or 22.5/45 label describes constraints; it does not mean equal weighting or guarantee a particular live concentration.

The issuer pages list annual expense ratios of 0.08% for XLV, 0.09% for VHT and 0.37% for IYH. At a hypothetical, unchanged $10,000 investment for one year, those rates correspond to about $8, $9 and $37. This is a simple fee illustration, not a forecast of actual account cost or return. It excludes changes in balance, transaction costs, bid-ask spreads, taxes and tracking differences.

Cost does not replace index research. XLV’s lower stated ratio does not make its S&P 500 universe broader, and IYH’s higher ratio does not prove that its different classification or cap rules are better. Compare the exposure you want first, then assess the stated fee using the current issuer pages for XLV, VHT and IYH.

Names that recur across top-ten lists suggest that the funds may share large issuers. But these N-PORT files have May, June and July reporting dates, so we did not calculate the total number of shared securities or a shared-weight figure. A defensible overlap study needs complete holdings for the same date. Match securities by ISIN first, then use CUSIP or issuer LEI where needed to distinguish share classes and corporate actions. Compare each matched security’s weight using each fund’s net assets as denominator. Ticker-only matching can miss multiple share classes or ticker changes.

XLV and VHT use GICS healthcare; IYH uses ICB healthcare. That matters when comparing them with broad-market or technology-sector funds. Healthcare and information technology are separate GICS sectors, yet a total-market fund can own companies in both. Adding a healthcare ETF to a broad-market portfolio increases the healthcare tilt; it does not add a wholly separate asset class. Healthcare technology labels also need the index provider’s taxonomy rather than assumptions based on a company’s ordinary-language description.

The practical comparison depends on desired company-size coverage and the healthcare tilt already embedded in a broad-market allocation. Index labels describe each fund’s starting universe, while holdings and weights change over time. Review the current methodology, portfolio date and fee together instead of treating an older top-ten report as today’s portfolio. This is a fund-construction comparison, not a performance ranking or purchase recommendation.

Form N-PORT is a periodic filing, not a real-time holdings screen. This analysis uses the latest periods available by September 26, 2026, and the ordinary-equity positions found in those reports. Quarterly rebalances, corporate actions, market prices and fund flows can change holdings and weights afterward. Issuer industry profiles can be dated differently from SEC reports, which is why every snapshot in the tables carries its own date.

Sector funds may hold many stocks, but they remain concentrated in one part of the U.S. equity market. They do not serve the same role as adding bonds, non-U.S. stocks or other asset classes. Read the basket rules, top holdings, fees and dates together, and do not treat one filed snapshot as a promise about future performance.