Check-up 35 in Germany: What is included, which blood tests are missing and what they cost you

The Check-up 35, officially the Gesundheitsuntersuchung (general health examination), has the same content at every practice, because a directive sets it rather than your doctor. That directive comes from the Federal Joint Committee (G-BA), the body that decides what Germany's statutory health insurance pays for. It names five building blocks.^[1]

1. Medical history. Your doctor asks about your own health, your family's health and your daily life. From that comes your risk profile: previous illnesses, heart attacks or cancer in the family, smoking, alcohol, exercise and stress.

2. Physical examination. Your doctor listens to your heart and lungs, feels your abdomen and looks at your skin, sensory organs, muscles, joints and nervous system. Weight, height and blood pressure are measured as well.

3. Lab work. From 35, the lab looks at two things in your blood and one in your urine.^[1] The blood test covers a full lipid profile, meaning total cholesterol, the "bad" LDL and the "good" HDL cholesterol and triglycerides, plus fasting plasma glucose, your blood sugar before breakfast. That full profile has been part of the check-up since April 2019, and before then only total cholesterol was measured.^[16] A urine dipstick checks for protein, glucose, red and white blood cells and nitrite, a sign of bacteria.^[1] Once from 35, the same blood sample also goes to a test for hepatitis B and C, which practices have been able to bill since October 2021.^{[1, 2, 15]}

4. Vaccination status. A look at your vaccination record, with a recommendation for any catch-up shots.

5. Counselling. Your doctor discusses the findings with you, talks about your cardiovascular risk and should point you to prevention programmes and cancer screening.

Two other screenings often happen around the same time but are not part of the check-up. Men from 65 are entitled to a one-time ultrasound of the abdominal aorta to look for an aneurysm, a bulge in the main artery in your belly. It has been covered as its own screening under the same directive since January 2018, so you can have it with or without a check-up.^{[1, 18]} Skin cancer screening from 35 every two years is often done on the same day. It runs under the cancer screening directive instead, though, and the G-BA is now reviewing it as well.^{[3, 13]}

Just as important is what is not included: no blood count, no ECG (a trace of your heartbeat) unless something is abnormal, and no ultrasound apart from the aorta screening. Liver, kidney and thyroid values are missing too, and so are HbA1c, your average blood sugar over recent months, and vitamin D. Under 35 the package is thinner still. Blood is only taken if you have a risk profile, for example obesity, high blood pressure or a family history, and there is no urine test at all.^[1]

From your 35th birthday, statutory insurance pays for the Check-up 35 every three years, and between 18 and 34 you get it once.^[1] The three-year interval is fairly new, since a reform decided in 2018 stretched it from two years to three.^[17]

Those three years are counted in calendar years: after a check-up, the next two calendar years are skipped. If you had it in March 2024, you are entitled again from 1 January 2027, a little before three full years are up.^[1]

For people with statutory insurance the check-up costs nothing. It runs on your insurance card with no co-payment, and the hepatitis and skin cancer screenings are covered too.^{[1, 3, 14]} Every statutory insurer also sets out in its statutes when using check-ups earns you a bonus, so it is worth asking yours.^[30]

Privately insured? Then the practice bills under the GOÄ, the official fee schedule for private medical bills, and you submit the invoice.^[23] Whether and how often your plan pays for check-ups depends on your tariff, so look it up before you book.

On a statutory plan, only the catalogue in the directive is free as a screening. Anything you add without a medical reason, such as ApoB, HbA1c, ferritin or a full blood count, is an IGeL (individual health service), a self-pay extra. If there is a medical reason, such as an abnormal finding or symptoms, your doctor can order further tests on your insurance as usual.^[19]

The catalogue itself may change, though. On 15 October 2026 the G-BA opened a review of the check-up.^[13] It covers the age limits, target groups, interval and content, including whether the check-up should focus on cardiovascular disease.^[13] The G-BA has also asked IQWiG, Germany's institute for quality and efficiency in health care, to assess the urine dipstick, a one-time HIV test and a check-up adapted to each person's risk.^[13] The law requires a decision by 31 December 2027, and until a new rule takes effect, everything described here still applies (as of October 2026).^{[13, 14]}

As a routine for everyone, general health checks have not measurably lowered deaths. A 2019 Cochrane review pooled the randomised trials that compared general health checks with no check, and the trials reporting results covered about 250,000 adults.^[4] Checks had little or no effect on overall or cancer deaths, and probably little or no effect on cardiovascular deaths.^[4] They may lead to more diagnoses, for example of high blood pressure or high cholesterol, though that evidence is of low certainty.^[4] Whether they lead to more treatment is unclear, because some trials saw more blood pressure medication and others did not.^[4]

Before you cancel the appointment, it helps to know how old many of these trials are. They started between 1963 and 1999, and the early ones ran before statins, the standard cholesterol drugs, or today's blood pressure drugs existed.^[4] Treatment has improved since then, which could make checks more useful today. But the review saw no trend over time, and a large trial that ran from 1999 to 2009 found no benefit either.^[4] In some trials the control groups also had check-ups, which blurs the difference in both directions.^[4]

If you keep the appointment, the practical question is whether it finds something you and your doctor can act on. That might be high blood pressure that gets treated, prediabetes you turn around early, or LDL cholesterol that stays high even though you live healthily. Findings like these are the reasonable case for keeping the free appointment, because the benefit comes from acting on them, not from the appointment itself.

Acting on a value only works for the values the panel measures, though, and for longevity the insurance panel has a gap. Its blood tests are built to catch diabetes and classic high cholesterol. They miss what many people want to see early: insulin resistance (when your cells respond poorly to insulin), low-grade inflammation, an inherited Lp(a) risk or the number of particles behind your LDL. Normal results at the check-up therefore only mean that the measured blood and urine values are normal. They say nothing about the risks the panel does not look at.

The insurance panel measures fasting glucose and four lipid values, so the tests below are what is missing for a fuller picture of your heart and metabolic risk. The prices are lab fees under the GOÄ fee schedule as of October 2026.^[23] Labs normally bill 1.15 times the base rate, and for lab tests they may charge at most 1.3 times, with no higher fee allowed even by agreement.^[23] Homocysteine has no GOÄ number of its own, so its range is a typical lab price. On top of the tests, each blood draw costs roughly 10 to 20 euros for the draw, materials and shipping.

The table shows what each value adds and what it costs you as a self-payer.

Source: GOÄ fee schedule, 1.15 to 1.3 times the base rate^[23]; homocysteine: typical lab price; as of October 2026. How to read each value is in the guide to the 8 longevity biomarkers.

Set price against purpose and two things stand out. The cheapest values, kidney function and liver enzymes, cost only about 8 to 9 euros together and are still missing from the panel^[23] The most expensive, homocysteine and vitamin D, have the thinnest case for routine testing, and fasting insulin, though cheaper, is not a routine test either.^{[10, 20, 28]}

Homocysteine, vitamin D and fasting insulin each make sense to measure for a specific reason, but none of them has a good case as a routine test. Each falls short in its own way, so they are worth taking one at a time.

Homocysteine is an amino acid in your blood that rises when B vitamins run low, and lowering it is easy. In a meta-analysis that pooled randomised trials, 0.8 mg of folic acid a day lowered homocysteine by around 23 percent.^[9] Even half that dose, 0.4 mg, reached about 90 percent of the effect.^[9] Vitamin B12 at around 0.4 mg a day lowered it by about 7 percent more, while vitamin B6 added nothing measurable.^[9]

The catch is what happens afterwards. When a Cochrane review pooled the trials that lowered homocysteine, the lower values prevented no heart attacks and no deaths, and only strokes became slightly rarer.^[10] So it is a marker you can move cheaply, with little change in what matters.

That leaves homocysteine mainly useful in the search for a B12 deficiency, and even there it is not the first test. If a deficiency is possible, for example on a vegan diet, on the diabetes drug metformin or on acid blockers, the first test is vitamin B12 itself.^[27] Homocysteine or methylmalonic acid, another marker of B12 status, help when that result is borderline.^[27] Numbness or tingling without an obvious cause belongs with a doctor soon, not in a self-pay panel.

If a test does show high homocysteine, do not start folic acid on your own. It can hide the anaemia of a vitamin B12 deficiency while nerve damage continues, which is why the EU upper limit for folic acid from supplements and fortified food is 1 mg a day.^[26] Have B12 checked first and decide on any supplement with your doctor.

Vitamin D has a large trial behind it. The VITAL trial gave more than 25,000 US adults, men from 50 and women from 55, either 2,000 IU of vitamin D3 a day or a placebo for about five years. Neither cancer nor cardiovascular events became rarer.^[11] The people in VITAL were not selected for low vitamin D, though, so the trial tested vitamin D as a general add-on rather than as the fix for a real deficiency.^[11] It also tested supplements, not whether measuring is useful.

Measuring is a separate question, and the 2024 Endocrine Society guideline took it up directly. It found no trial evidence for routine testing, including in people with dark skin or obesity, and advises against it.^[28] For people aged 75 and over it suggests taking vitamin D without testing first.^[28] A test makes sense with a medical reason, such as osteoporosis or malabsorption (your gut absorbs nutrients poorly), and that is a conversation with your doctor.

Fasting insulin is cheap, and together with fasting glucose it gives you HOMA-IR, a research index of insulin resistance that the HOMA-IR calculator works out for you.^[7] In the Whitehall II study, insulin sensitivity, meaning how well your body responds to insulin, fell steeply over the five years before a diabetes diagnosis.^[12] Fasting glucose, by contrast, rose only slowly and climbed steeply in the last three years.^[12] Those are averages across a group, not a forecast for one person.^[12]

That group signal has not made insulin a screening test. A joint lab guideline from the American Diabetes Association and US laboratory medicine experts does not recommend routine insulin testing for most people with diabetes or at risk of diabetes or heart disease.^[20] It calls the test mainly useful for research.^[20] Labs also measure insulin with different test kits, so results do not compare well between labs, and there is no agreed cut-off.^[20] If you measure it anyway, you need a real overnight fast, and the result is best read with your doctor as one value among others.

You can ask your GP to add extra blood tests to the check-up, and that is the easiest route, because blood is drawn anyway. Tell the practice beforehand which extra values you want. It then sends the tubes to the lab with a second order and bills the extras privately under the GOÄ.^[23] Before an IGeL, the practice has to tell you in writing what it costs and get your explicit consent, usually with a written agreement you sign.^[19] So ask for the price first.

Some practices decline, because the billing is too much hassle for them or because they judge the benefit differently. That is not a failing on your doctor's part, since they follow the catalogue. You then still have a second route, a self-pay lab or an online provider, which the self-pay guide compares with prices. Both routes are paid out of your own pocket, which is why the third one is worth knowing.

The third route is a medical reason, which doctors call an indication. If there is one, your doctor can order further tests on your insurance, for example HbA1c when your glucose is abnormal.^[19] Whether ApoB or Lp(a) is covered then depends on your findings, such as a family history of early heart disease or a very high LDL. Your doctor makes that call based on the findings, not on your request.

Whichever route you take, five things make the values worth having:

• Come fasted. The directive asks for fasting plasma glucose,^[1] and labs usually mean 8 to 12 hours with water only. Glucose and insulin depend on it; triglycerides only a little.^[25]
• Do not test during or just after an infection. Ferritin rises with inflammation,^[22] and an hs-CRP above 10 mg/L points to acute inflammation and should be repeated once you are well.^[31] Lp(a) can also shift in acute illness, so test it when you are well.^[6]
• Tell the practice which supplements you take. High-dose biotin, common in hair and nail products, can distort some lab tests, and the lab will tell you whether to pause it.^[29] If you take insulin or other glucose-lowering medicine, agree the fasting plan with your doctor beforehand.
• Ask for Lp(a) in nmol/L and for ApoB as its own line item, not as part of a package you do not need.^[6]
• Take the report home. The values belong to you, and you need them to compare next time.

For most people who want a baseline, the extra blood tests with the best case cost roughly 95 to 115 euros on top of the free check-up, including the draw (as of October 2026).^[23] That figure starts from the full list in the table: all ten values plus the draw come to roughly 175 to 220 euros. Leaving out homocysteine and vitamin D, as the evidence allows, saves 60 to 80 euros. Leaving out fasting insulin, which lab guidelines do not recommend as a routine test, saves another 17 to 19 euros.^[20] Because Lp(a) usually needs measuring only once, every later round costs less again.^[6]

Longevity clinics charge considerably more. One Berlin clinic, for example, lists packages from 590 euros (blood tests plus a carotid ultrasound) up to packages from 2,500 euros, as of October 2026.^[24] Depending on the package, they add imaging, further examinations and a doctor's interpretation to the lab tests.^[24] The free check-up plus a few targeted self-pay values covers the key blood values for a fraction of the price, though without imaging or long consultations.

Whether even the cheaper route pays off depends on the question behind it. The extras are most worth it when they answer a question about your own risk. That can be a first baseline from your mid-30s, a heart attack or stroke in the family, belly fat, high triglycerides or an HbA1c at the borderline. Age alone does not justify the whole panel, and fasting insulin does not belong in a routine baseline.^[20] Lp(a) is the exception, since the European Atherosclerosis Society recommends measuring it at least once in every adult.^[6]

You can skip a round if you had the values within the last one to two years and they were normal, because most of them move slowly. Values that were abnormal or borderline, such as an HbA1c in the prediabetic range, or values your doctor is monitoring, follow your doctor's schedule instead. Under 35 with no risk factors, the one-time insurance check plus perhaps Lp(a) is enough.

A reasonable first step is to bring a short list of the extra tests that fit you to your next check-up, so they come from the same draw. Then agree with your doctor which of them would really help and how you will go through the results together. What your values mean, and whether you change anything, is a decision you make with them.