Check-up 35 in Germany: What Is Included, Which Blood Tests Are Missing and What They Cost You

The Check-up 35 is officially called the Gesundheitsuntersuchung, the general health examination. What exactly it includes is not up to your practice. It is set out in the health examination directive of the Federal Joint Committee (G-BA), the body that defines the benefits catalogue of Germany's statutory health insurance ^[1]. The directive names five building blocks.

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, stress.

2. Physical examination. A full-body status: listening to heart and lungs, palpating the abdomen, skin, sensory organs, musculoskeletal system, nervous system, plus weight, height and blood pressure.

3. Lab work. From 35, two things from blood and one from urine. Blood: a complete lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides) and fasting plasma glucose (your blood sugar before breakfast). Urine: a dipstick test for protein, glucose, red cells, white cells and nitrite (a sign of bacteria). The complete lipid profile has been included since April 2019; before that only total cholesterol was measured.

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

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

Separate: ultrasound of the abdominal aorta (men from 65 only). A one-time ultrasound screening for an abdominal aortic aneurysm, a bulge in the main artery in your belly. It is its own screening under the same directive since the 2019 revision, so you can get it with or without a check-up ^[1].

One extra is part of the check-up itself: since October 2021, from 35 you are entitled once to a hepatitis B and C test, drawn from the same blood sample ^{[1, 2]}. Another runs separately but is often done on the same day: skin cancer screening from 35 every two years belongs to the cancer screening directive, not to the check-up itself ^[3].

Just as important is what is not included. No full blood count, no ECG (only if something is abnormal), no ultrasound apart from the aorta screening for men from 65, no liver, kidney or thyroid values, no HbA1c, no vitamin D. And under 35, blood is only drawn if a risk profile exists, for example obesity, high blood pressure or a family history. The urine test is missing entirely under 35.

From your 35th birthday, every three years. Between 18 and 34, once. The directive puts it in legal language: once from the completion of the 18th year of life up to the end of the 35th, then every three years from the completion of the 35th year of life ^[1]. Your 35th year of life ends on your 35th birthday. Until 2018 the interval was two years; since the reform it is three. The clock runs by calendar year. After a check-up, the next two calendar years are skipped. Had it in March 2024? You are entitled again from 1 January 2027 ^[1].

Cost: nothing for people with statutory insurance. The check-up runs on your insurance card, with no co-payment. Hepatitis screening and skin cancer screening are also covered. Many insurers even reward participation through their bonus programme.

Privately insured? Then the practice bills according to the GOÄ fee schedule and you submit the invoice. Most plans cover preventive examinations, often more frequently than every three years. Check your plan.

One note so you read the bill correctly: only the catalogue in the directive is free. Anything you want on top, meaning ApoB, HbA1c, ferritin or a full blood count, is an IGeL (individual health service) and is billed to you privately. That is what the rest of this guide is about.

As a routine ritual: not measurably. The 2019 Cochrane review pooled 17 randomised trials with more than 250,000 adults in which general health checks were compared with no check. Result: no effect on all-cause mortality, none on cardiovascular mortality, none on cancer mortality ^[4]. The checks found more high blood pressure and more lipid disorders and led to more treatment. There were still no fewer deaths.

Before you cancel the appointment, two points of context. First, many of the studies are old. They started between 1963 and 1999, and the early ones ran before statins or today's blood pressure therapy existed. Second, the studies invited people who partly went to the doctor regularly anyway. That dilutes the measurable difference.

The real lesson is a different one: it is not the check that helps, it is what you do with individual values. High blood pressure that gets treated. Prediabetes that you turn around early. An LDL that stays high although you live healthily. The value is in the marker, not in the appointment.

For longevity, that creates a problem. The insurance blood tests are built to catch diabetes and classic high cholesterol (hyperlipidaemia). The panel is blind to what you want to see early: insulin resistance, silent inflammation, genetic Lp(a) risk or the particle count behind your LDL. So a clean check-up does not mean everything is fine. It means the five blood values and the urine strip that were measured are fine.

The insurance panel measures fasting glucose and four lipid values. For a full picture of your heart and metabolic risk, the following values are missing. The prices are typical self-pay ranges in Germany. They depend on the lab and on the GOÄ multiplier, the factor applied to the official fee schedule. For lab work it is usually 1.15. Per blood draw, add roughly 10 to 20 euros for the draw, materials and shipping.

Test	What it tells you	Typical self-pay price
ApoB	Counts the artery-damaging particles instead of just their cholesterol. ESC/EAS guideline: class I (strongest) recommendation with high triglycerides, diabetes, obesity, metabolic syndrome [5]	10 to 25 euros
Lp(a)	Genetic cardiovascular risk, more than 90 percent inherited. EAS consensus: measure at least once as an adult [6]	20 to 40 euros
HbA1c	Blood sugar average of the last three months, shows prediabetes even with normal fasting glucose	13 to 20 euros
Fasting insulin (HOMA-IR)	Insulin resistance, often years before fasting glucose climbs sharply [7, 12]	15 to 25 euros
hs-CRP	Silent inflammation. In the Women's Health Study a stronger predictor of cardiac events than LDL cholesterol [8]	13 to 25 euros
Ferritin	Iron stores, shows deficiency and overload	15 to 25 euros
Homocysteine	B-vitamin status, limited value for the heart (see next section)	30 to 45 euros
Vitamin D (25-OH)	Supply, benefit of routine measurement disputed (see next section)	30 to 45 euros
Creatinine with eGFR	Kidney function (eGFR, an estimate of how well your kidneys filter), important before any medication and with high blood pressure	3 to 10 euros
ALT (GPT) and GGT	Liver enzymes, first hint of a fatty liver	5 to 10 euros

Two things stand out. The cheapest values on the list, kidney function and liver values, cost 8 to 20 euros together and are still missing. And the most expensive, homocysteine and vitamin D, are precisely the ones with the thinnest evidence.

How to read the individual values is explained in the guide to the 8 longevity biomarkers. What is behind ApoB and Lp(a) and when insurance does pay for them is in the ApoB and Lp(a) guide. From fasting glucose and fasting insulin, the HOMA-IR calculator works out the index for you.

A note on insurance: if there is an indication, it covers individual values outside the check-up too. HbA1c with abnormal glucose, creatinine with high blood pressure, ferritin with suspected iron deficiency. Your doctor decides that based on findings, not on request.

Three values from the list deserve a reality check before you pay for them.

Homocysteine (an amino acid in your blood that rises when B vitamins run low). Lowering it is easy. In a meta-analysis of 25 randomised trials, 0.8 mg of folic acid a day lowered homocysteine by around 23 percent. Vitamin B12, at around 0.4 mg a day, added another 7 percent, vitamin B6 nothing measurable ^[9]. The problem is what happens afterwards: nothing. The 2017 Cochrane review evaluated 15 trials with around 71,000 participants. Lowering homocysteine prevented no heart attacks and no deaths; only stroke risk fell slightly ^[10]. A marker you can move cheaply without the outcome demonstrably changing. Measuring it makes sense when a B12 deficiency is a possibility: on a vegan diet, on metformin or acid blockers, with unexplained nerve symptoms. As a routine heart marker for 30 to 45 euros, not really.

Vitamin D. The VITAL trial gave 25,871 US adults (men from 50, women from 55) 2,000 IU of vitamin D3 a day or placebo for about five years. Neither cancer nor cardiovascular events became rarer ^[11]. That does not mean a deficiency is irrelevant. It means routine measurement in healthy people with normal sun exposure has little consequence. With little sun, darker skin, older age, osteoporosis or malabsorption (your gut absorbs nutrients poorly) it looks different. That is a conversation with your doctor, not a default tick box.

Fasting insulin. Here it is the other way round: cheap, informative, but not on the insurance slip. From fasting glucose and fasting insulin you get HOMA-IR, an index for insulin resistance described by Matthews and colleagues in 1985 ^[7]. In the Whitehall II study, insulin sensitivity fell steeply in the five years before a diabetes diagnosis, while fasting glucose crept up slowly and only shot up in the last three ^[12]. Two caveats. Labs measure insulin with different test kits, so results do not compare perfectly from lab to lab. And you must be truly fasted, 8 to 12 hours. The HOMA-IR calculator works out the index for you. What it means, you discuss with your doctor, not with a table from the internet.

Yes, and it is the easiest route. Blood is drawn at the check-up anyway. Tell the practice beforehand which extra values you want. They send the tubes to the lab with a second order and bill the extras privately under the GOÄ. Beforehand you have to sign a written IGeL agreement; that is mandatory and protects you from surprises on the invoice. Ask for the price before you sign.

Some practices decline because the billing is too cumbersome for them or because they judge the benefit differently. That is not a failing on your doctor's part; they follow the catalogue. In that case the second route remains: a self-pay lab or an online provider that sends your sample to the same large laboratories. How that works and what the providers cost is in the self-pay guide.

There is a third route that is often overlooked: the indication. Your doctor can order ApoB, Lp(a) or HbA1c at insurance expense if there is a reason: a family history (heart attack or stroke in parents or siblings before 60), high triglycerides, obesity or diabetes. A documented family history is the strongest argument you can bring.

For the values to be worth anything, four things:

• Come fasted for 8 to 12 hours; water is allowed. Glucose, insulin and triglycerides depend on it.
• Do not measure during an infection or right after a vaccination. hs-CRP, ferritin and Lp(a) rise temporarily.
• 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.
• Take the report home. The values belong to you, and you need them for the comparison next time.

The short version: the extras worth having cost around 100 to 200 euros, a fraction of a clinic package. Here is the maths. The complete list from the section above, all ten values plus draw and shipping, lands at roughly 150 to 300 euros depending on the lab. If you leave out homocysteine and vitamin D, which the evidence justifies, you save 60 to 90 euros and end up at around 100 to 200 euros. And because Lp(a) usually needs measuring only once, every further round gets cheaper still.

For comparison: longevity clinics in Germany sell entry packages without imaging from about 1,500 to 2,500 euros; with whole-body MRI and omics (large-scale gene and molecule profiling) it goes up to 20,000 euros. The blood part of these packages often runs through the same large labs your GP practice uses. The free check-up plus 100 to 200 euros of IGeL values gives you most of the blood information for a fraction of the price. What you do not get is the imaging, the consultation time and the nice PDF.

When it is worth it: the first time from your mid-30s, to have a baseline. With heart attack or stroke in the family. With belly fat, high triglycerides or an HbA1c at the borderline. And Lp(a) at least once for everyone, as the EAS consensus recommends ^[6].

When you can skip it: if you already had the values within the last one to two years, because most of them move slowly. If you are under 35 with no risk factors, the one-time insurance check plus perhaps Lp(a) is enough. And if you have nobody to discuss the result with. A value nobody acts on is information with stress potential, nothing more.

This guide describes what the check-up measures and what it leaves out. What your values mean for you and whether you should change anything, you decide with your doctor.