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

_By Maurice Lichtenberg · Published 2026-09-05 · Updated 2026-10-21_

The Check-up 35 (Gesundheitsuntersuchung) is a free health check at your GP, paid by German statutory insurance every three years from 35 and once between 18 and 34 [1]. From 35 it covers a physical exam with blood pressure, fasting glucose, a lipid profile, a urine test and a one-time hepatitis B and C test [1, 15]. It misses values such as ApoB, Lp(a) and the long-term blood sugar HbA1c, and adding the ones that fit your own risk costs roughly 95 to 115 euros with the draw (as of October 2026) [23]. The G-BA opened a review of the check-up in October 2026, but the current rules apply until it decides, which the law requires by the end of 2027 [13, 14].

The public-insurance health check from age 35 is free but narrow. What the G-BA directive includes, which blood tests it leaves out, what adding them costs as of October 2026, and which ones are worth paying for.

## On this page

- What is included in the Check-up 35?
- How often do you get it and what does it cost?
- Does the Check-up 35 help at all?
- Which blood tests are missing, and what they cost
- Homocysteine, vitamin D, fasting insulin: thin evidence
- Can I add the missing tests at my GP?
- Is it worth paying for the extra tests?

## What is included in the Check-up 35 and which blood tests are done?

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].

- The G-BA directive sets five building blocks: medical history, a full-body exam with blood pressure, lab work, a vaccination check and counselling [1].
- From 35 the lab work is a lipid profile (total cholesterol, LDL, HDL, triglycerides) and fasting glucose from blood, plus a urine dipstick test [1].
- Once from 35 you get a hepatitis B and C test from the same blood sample, which practices have billed as part of the check-up since October 2021 [2, 15].
- Men from 65 get a separate one-time ultrasound of the abdominal aorta to look for an aneurysm [1].
- Skin cancer screening from 35 every two years runs under the cancer screening directive, not the check-up [3].
- A blood count, an ECG, liver, kidney and thyroid values, HbA1c and vitamin D are not included [1].

## How often do you get the Check-up 35 and what does it cost?

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].

- Statutory insurance pays for the check-up every three years from 35 and once between 18 and 34 [1].
- It runs by calendar year: after a check-up, the next two calendar years are skipped [1].
- It is free with statutory insurance [14], and each insurer's statutes set out when it earns you a bonus [30].
- Privately insured people submit the GOÄ invoice, and whether the plan pays depends on the tariff [23].
- Extra tests without a medical reason are IGeL and cost extra; with a medical reason, insurance can pay [19].
- As of October 2026 the G-BA is reviewing the check-up, with a decision due by the end of 2027; the current rules apply until then [13, 14].

## Does the Check-up 35 help at all? What the Cochrane review shows

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.

- In a 2019 Cochrane review of randomised trials with about 250,000 adults, general health checks brought no measurable drop in overall or cancer deaths, and probably none in cardiovascular deaths [4].
- Many trials predate statins and modern blood pressure drugs, but the review found no sign that newer trials show a benefit [4].
- Checks may lead to more diagnoses, but whether they lead to more treatment is unclear [4].
- Where a check-up helps, it is through single treatable findings such as high blood pressure, raised glucose and high LDL cholesterol.
- The insurance panel is blind to insulin resistance, inflammation and Lp(a), so a clean result only means the measured values are clean.

## Which blood tests are missing from the Check-up 35? The list with self-pay prices

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.

| Test | What it tells you | Self-pay lab fee (GOÄ) |
| --- | --- | --- |
| ApoB | Counts the particles that damage arteries, not just their cholesterol. European heart and cholesterol guidelines recommend it, based on expert consensus, especially with high triglycerides, diabetes, obesity, metabolic syndrome or very low LDL [5]. More in the [ApoB and Lp(a) guide](/en/guide/apob-lpa) | 13 to 15 euros |
| Lp(a) | Inherited cardiovascular risk, more than 90 percent set by your genes. The European Atherosclerosis Society advises measuring it at least once in every adult [6] | 20 to 23 euros |
| HbA1c | Average blood sugar over the last two to three months; can show prediabetes while fasting glucose is still normal [20] | 13 to 15 euros |
| Fasting insulin (HOMA-IR) | With fasting glucose, gives an index of insulin resistance used in research [7]. Not recommended for routine testing [20] | 17 to 19 euros |
| hs-CRP | Low-grade inflammation. Predicted cardiovascular events at least as well as LDL in a large study of women [8], but added little to standard risk factors in pooled data [21]. Measure when you are not ill [31] | 13 to 15 euros |
| Ferritin | Iron stores. A low value points to deficiency; a high one more often comes from inflammation, fatty liver, alcohol or metabolic syndrome than from iron overload, and needs a second iron value, transferrin saturation, to judge [22] | 17 to 19 euros |
| Homocysteine | B-vitamin status, little value for the heart (see next section) [10] | 30 to 45 euros (typical lab price) |
| Vitamin D (25-OH) | Vitamin D supply; routine testing not recommended (see next section) [28] | 32 to 36 euros |
| Creatinine with eGFR | Kidney function (eGFR estimates how well your kidneys filter); matters with high blood pressure, diabetes and before medicines that are dosed by kidney function or can strain the kidneys | about 3 euros |
| ALT (GPT) and GGT | Liver enzymes, a first hint of fatty liver | 5 to 6 euros |

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](/en/guide/longevity-bluttest-biomarker).

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].

- All ten missing values together cost roughly 175 to 220 euros self-pay, including 10 to 20 euros for the draw and shipping (as of October 2026) [23].
- ApoB (13 to 15 euros) is recommended by European heart and cholesterol guidelines on the basis of expert consensus, especially with diabetes, high triglycerides, obesity or metabolic syndrome [5].
- Lp(a) (20 to 23 euros) usually needs only one measurement, because more than 90 percent of the value is set by your genes [6].
- Kidney function and liver values cost about 8 to 9 euros together and are still missing from the insurance panel [23].
- hs-CRP and ferritin are context values: hs-CRP adds little to standard risk factors, and a high ferritin more often reflects inflammation or fatty liver than iron overload [21, 22].

## Homocysteine, vitamin D, fasting insulin: Where the evidence gets thin

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](/en/tools/homa-ir) 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.

- 0.8 mg of folic acid a day lowers homocysteine by around 23 percent, and 0.4 mg already gets about 90 percent of that effect [9].
- Lowering homocysteine prevented no heart attacks and no deaths; only strokes became slightly rarer [10].
- Do not take folic acid without checking B12 first: it can hide a B12 deficiency, and the EU upper limit from supplements and fortified food is 1 mg a day [26].
- VITAL found no drop in cancer or cardiovascular events with vitamin D, and the 2024 Endocrine Society guideline advises against routine vitamin D testing [11, 28].
- Fasting insulin gives HOMA-IR, but a US diabetes and lab medicine guideline does not recommend routine insulin testing, and results differ between labs [7, 20].

## Can I add the missing tests at my GP?

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](/en/guide/selbstzahler-longevity) 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.

- The extras come from the same check-up blood draw and are billed privately under the GOÄ; the practice must tell you the price in writing and get your consent first [19, 23].
- If the practice declines, a self-pay lab or an online provider can run the tests.
- With a medical reason, such as abnormal glucose, your doctor can order further tests on insurance; the findings decide, not your request [19].
- Come fasted, do not test while ill, mention supplements such as biotin, ask for Lp(a) in nmol/L and take the report home [25, 29].

## Is it worth paying for the extra tests? The maths and when to skip them

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.

- All ten missing values cost roughly 175 to 220 euros; without homocysteine, vitamin D and fasting insulin, roughly 95 to 115 euros (as of October 2026) [20, 23].
- Longevity clinics charge considerably more: one Berlin clinic lists packages from 590 euros up to packages from 2,500 euros that add imaging and other examinations [24].
- Choose extras that answer a question about your own risk, such as a first baseline, a family history, belly fat or high triglycerides.
- Lp(a) is worth measuring once in every adult, while fasting insulin does not belong in a routine baseline [6, 20].
- You can skip a round if recent values were normal; abnormal or borderline values follow your doctor's schedule.
- This guide describes the tests; what your values mean is for you and your doctor to decide.


## FAQ

### How often do I get the Check-up 35?

From your 35th birthday you get the Check-up 35 every three years, and once between 18 and 34, as the G-BA health examination directive sets out [1]. It runs by calendar year, so after a check-up the next two calendar years are skipped. Skin cancer screening is available from 35 every two years, and hepatitis B and C screening once from 35 [2, 3].

### What happens at the check-up under 35?

Between 18 and 34 you get the check-up once, free of charge, with your medical history, a physical exam with blood pressure, a look at your vaccination record and counselling [1]. Blood for the lipid profile and fasting glucose is only taken if you have a risk profile, such as obesity, high blood pressure or a family history. The urine test and the hepatitis B and C screening only start at 35 [1, 2].

### What does the Check-up 35 cost?

Nothing for people with statutory insurance: the check-up runs on your insurance card without co-payment [14]. You only pay for extras you add without a medical reason, such as ApoB, HbA1c or ferritin, which count as IGeL; with a medical reason, your doctor can order further tests as normal statutory care [19]. Privately insured people submit the GOÄ invoice to their insurer [23].

### Which blood tests are missing from the Check-up 35?

In blood, the check-up measures only fasting glucose and the lipid profile (total cholesterol, LDL, HDL, triglycerides) [1]. For a fuller view of heart and metabolic risk, ApoB, Lp(a), HbA1c, hs-CRP, ferritin, creatinine with eGFR and the liver values ALT and GGT are missing, with fasting insulin (HOMA-IR) as an optional extra that lab guidelines do not recommend routinely [5, 6, 20]. A full blood count, thyroid values and vitamin D are not included either.

### Does the Check-up 35 include a blood count or thyroid values?

No. Neither a small nor a full blood count is included, and neither is TSH for the thyroid, because in blood the directive covers only fasting glucose and the lipid profile [1]. If there is a reason, such as fatigue, paleness or suspected iron deficiency or thyroid problems, your doctor can order these as normal statutory care [19]. Without a reason, you can add them to the check-up blood draw as an IGeL and pay yourself.

### Is an ECG or ultrasound part of the Check-up 35?

An ECG is not. Your doctor only does one if symptoms or findings call for it, and then insurance pays for it as a separate service. Ultrasound is not part of it either, except that the same directive gives men from 65 a separate one-time right to an ultrasound screening of the abdominal aorta for an aneurysm, a dangerous bulge in the artery [1]. Ultrasound of the abdomen, thyroid or heart is otherwise not included.

### What does fasting insulin cost if I pay myself?

About 17 to 19 euros as a GOÄ lab fee, plus roughly 10 to 20 euros for the draw and shipping if you order it on its own (as of October 2026) [23]. Together with the fasting glucose from the check-up it gives you HOMA-IR, which our calculator works out [7]. The US diabetes and lab medicine guideline (ADA/AACC) does not recommend routine insulin testing for most people, so treat it as a context value to discuss with your doctor, not as a screening test [20].

### How can I lower homocysteine?

B vitamins lower it: in trials, 0.8 mg of folic acid a day lowered homocysteine by around 23 percent, and B12 added about 7 percent more [9]. Lowering it prevented no heart attacks and no deaths, though, and only strokes became slightly rarer [10]. Do not start folic acid on your own, because it can hide a B12 deficiency while nerve damage continues, which is why the EU upper limit from supplements and fortified food is 1 mg a day [26]. Have B12 checked first and decide with your doctor whether a supplement makes sense.

### Can I add the missing tests at my GP?

Yes. Tell the practice before the blood draw which extra values you want; it has to give you the price in writing and get your consent before billing them privately under the GOÄ [19, 23]. If the practice declines, a self-pay lab or an online provider can run the tests. With a medical reason, your doctor can order single values on insurance, and the findings decide [19].

### From what age are ApoB and Lp(a) worth it?

Lp(a) is more than 90 percent genetically determined, reaches adult levels in childhood and then barely changes, although in women it tends to rise at menopause; the 2022 EAS consensus therefore recommends measuring it at least once in every adult, at almost any age [6]. European heart and cholesterol guidelines (ESC/EAS) recommend ApoB for risk assessment especially with high triglycerides, diabetes, obesity or metabolic syndrome, or a very low LDL [5]. A family history of early heart disease is another good reason to ask, but that is our reading, not the guideline's list. Without risk factors, the first check-up at 35 is a good time for a baseline.

### Do I have to fast for the Check-up 35? Is coffee allowed?

Yes, because the directive specifies fasting plasma glucose [1], and labs usually mean 8 to 12 hours without food, with water allowed. Save coffee for after the draw too, even black, because fasting glucose and insulin need a real fast, while triglycerides are only slightly higher after a normal meal [25]. Tell the practice which supplements you take, because high-dose biotin can distort some lab tests [29]. If you take insulin or other glucose-lowering medicine, agree the fasting plan with your doctor beforehand, and ask whether to take other medicines as usual.

### Is the Check-up 35 changing?

It may. On 15 October 2026 the G-BA opened a review of the check-up covering its age limits, target groups, interval and content, including whether it should focus on cardiovascular disease [13]. The law requires a decision by 31 December 2027, and until a new rule takes effect the current check-up applies unchanged (as of October 2026) [13, 14].

### Do I need a vitamin D test?

Usually not as a routine. The 2024 Endocrine Society guideline found no trial evidence for routine vitamin D testing in the general population, including people with dark skin or obesity, and advises against it [28]. In the VITAL trial, vitamin D supplements did not lower cancer or cardiovascular events in older adults who were not selected for low levels [11]. A test makes sense with a medical reason, such as osteoporosis or malabsorption, which your doctor can judge.

## Sources

- Gemeinsamer Bundesausschuss. (2020). Richtlinie über die Gesundheitsuntersuchungen zur Früherkennung von Krankheiten (Gesundheitsuntersuchungs-Richtlinie). Gemeinsamer Bundesausschuss. https://www.g-ba.de/richtlinien/10/
- Gemeinsamer Bundesausschuss, Pressemitteilung vom 20. November 2020. (2020). Screening auf Hepatitis B und C neuer Bestandteil des Gesundheits-Check-ups. Gemeinsamer Bundesausschuss. https://www.g-ba.de/presse/pressemitteilungen-meldungen/912/
- Gemeinsamer Bundesausschuss. (2025). Richtlinie über die Früherkennung von Krebserkrankungen (Krebsfrüherkennungs-Richtlinie, KFE-RL). Gemeinsamer Bundesausschuss. https://www.g-ba.de/richtlinien/17/
- Krogsbøll LT, Jørgensen KJ, Gøtzsche PC. (2019). General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD009009.pub3
- Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al.; ESC Scientific Document Group. (2020). 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. European Heart Journal. https://doi.org/10.1093/eurheartj/ehz455
- Kronenberg F, Mora S, Stroes ESG, Ference BA, Arsenault BJ, Berglund L, et al. (2022). Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. European Heart Journal. https://doi.org/10.1093/eurheartj/ehac361
- Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. (1985). Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. https://doi.org/10.1007/BF00280883
- Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. (2002). Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa021993
- Homocysteine Lowering Trialists' Collaboration. (2005). Dose-dependent effects of folic acid on blood concentrations of homocysteine: a meta-analysis of the randomized trials. American Journal of Clinical Nutrition. https://doi.org/10.1093/ajcn/82.4.806
- Martí-Carvajal AJ, Solà I, Lathyris D, Dayer M. (2017). Homocysteine-lowering interventions for preventing cardiovascular events. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD006612.pub5
- Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, et al.; VITAL Research Group. (2019). Vitamin D supplements and prevention of cancer and cardiovascular disease. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa1809944
- Tabák AG, Jokela M, Akbaraly TN, Brunner EJ, Kivimäki M, Witte DR. (2009). Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. The Lancet. https://doi.org/10.1016/S0140-6736(09)60619-X
- Gemeinsamer Bundesausschuss, Meldung vom 15. Oktober 2026. (2026). Hautkrebs-Screening und Check-up: G-BA berät über das aktuelle Früherkennungsangebot. Gemeinsamer Bundesausschuss. https://www.g-ba.de/presse/pressemitteilungen-meldungen/1357/
- Bundesministerium der Justiz. (2026). Sozialgesetzbuch (SGB) Fünftes Buch, § 25 Gesundheitsuntersuchungen. gesetze-im-internet.de. https://www.gesetze-im-internet.de/sgb_5/__25.html
- Bewertungsausschuss nach § 87 Abs. 1 Satz 1 SGB V. (2021). Beschluss des Bewertungsausschusses in seiner 567. Sitzung am 4. August 2021 zur Änderung des EBM mit Wirkung zum 1. Oktober 2021 (GOP 01734, 01744: Screening auf Hepatitis B und C). Kassenärztliche Vereinigung Sachsen-Anhalt. https://www.kvsa.de/fileadmin/user_upload/PDF/Praxis/EBM_2021/2021_4/Aufnahme_GOP_01734__01744_-_Screening_auf_Hepatitis_B__C.pdf
- Bewertungsausschuss nach § 87 Abs. 1 Satz 1 SGB V. (2019). Beschluss des Bewertungsausschusses in seiner 435. Sitzung am 29. März 2019 zur Änderung des EBM mit Wirkung zum 1. April 2019 (GOP 32882 Lipidprofil). Kassenärztliche Vereinigung Sachsen-Anhalt. https://kvsa.de/fileadmin/user_upload/PDF/Praxis/EBM_2019/2019_2/AEnderungen_zu_Laborleistungen_im_Rahmen_des_Check-up.pdf
- Gemeinsamer Bundesausschuss. (2018). Gesundheitsuntersuchungs-Richtlinie: Anpassung der ärztlichen Gesundheitsuntersuchungen für Erwachsene (Beschluss vom 19.07.2018, in Kraft 25.10.2018). Gemeinsamer Bundesausschuss. https://www.g-ba.de/beschluesse/3427/
- Bewertungsausschuss nach § 87 Abs. 1 Satz 1 SGB V. (2018). Beschluss des Bewertungsausschusses in seiner 410. Sitzung zur Änderung des EBM mit Wirkung zum 1. Januar 2018 (GOP 01747, 01748: Ultraschallscreening auf Bauchaortenaneurysmen). Kassenärztliche Vereinigung Sachsen-Anhalt. https://www.kvsa.de/fileadmin/user_upload/PDF/Praxis/EBM_2018/1_2018/EBM_1_8_Aufnahme_AS_1_7_2.pdf
- Bundesministerium für Gesundheit, gesund.bund.de. (2025). Individuelle Gesundheitsleistungen (IGeL). gesund.bund.de. https://gesund.bund.de/individuelle-gesundheitsleistungen-igel
- Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. (2023). Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care. https://doi.org/10.2337/dci23-0036
- Emerging Risk Factors Collaboration; Kaptoge S, Di Angelantonio E, Pennells L, et al. (2012). C-reactive protein, fibrinogen, and cardiovascular disease prediction. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa1107477
- European Association for the Study of the Liver. (2022). EASL Clinical Practice Guidelines on haemochromatosis. Journal of Hepatology. https://doi.org/10.1016/j.jhep.2022.03.033
- Bundesministerium der Justiz. (2026). Gebührenordnung für Ärzte (GOÄ): § 2 (no fee agreements for lab tests), § 5 (fee range 1.0 to 1.3 times for Section M) and Gebührenverzeichnis, Abschnitt M (Laboratoriumsuntersuchungen). gesetze-im-internet.de. https://www.gesetze-im-internet.de/go__1982/
- Tutkun Clinics. (2026). Longevity Check Berlin (package prices, retrieved October 2026). tutkunclinics.de. https://tutkunclinics.de/longevity-check-berlin/
- Nordestgaard BG, Langsted A, Mora S, Kolovou G, Baum H, Bruckert E, et al. (2016). Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points - a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. European Heart Journal. https://doi.org/10.1093/eurheartj/ehw152
- Scientific Committee on Food; EFSA Scientific Panel on Dietetic Products, Nutrition and Allergies. (2006). Tolerable Upper Intake Levels for Vitamins and Minerals. European Food Safety Authority. https://www.efsa.europa.eu/sites/default/files/efsa_rep/blobserver_assets/ndatolerableuil.pdf
- Stabler SP. (2013). Vitamin B12 deficiency. New England Journal of Medicine. https://doi.org/10.1056/NEJMcp1113996
- Demay MB, Pittas AG, Bikle DD, Diab DL, Kiely ME, Lazaretti-Castro M, et al. (2024). Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgae290
- Li D, Ferguson A, Cervinski MA, Lynch KL, Kyle PB. (2020). AACC Guidance Document on Biotin Interference in Laboratory Tests. Journal of Applied Laboratory Medicine. https://doi.org/10.1093/jalm/jfz010
- Bundesministerium der Justiz. (2026). Sozialgesetzbuch (SGB) Fünftes Buch, § 65a Bonus für gesundheitsbewusstes Verhalten. gesetze-im-internet.de. https://www.gesetze-im-internet.de/sgb_5/__65a.html
- Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, et al. (2003). Markers of inflammation and cardiovascular disease: application to clinical and public health practice. A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. https://doi.org/10.1161/01.CIR.0000052939.59093.45

_Full guide: https://longevity-cities.com/en/guide/check-up-35-blutwerte_

---

_Canonical: https://longevity-cities.com/en/guide/check-up-35-blutwerte · Part of Longevity Cities · Updated 2026-10-21_