Preventive Care: The Complete Guide

Key numbers at a glance

What preventive care is and why it matters

Preventive care is health care for people who feel fine. It has two main jobs. The first is stopping disease before it starts, through vaccines, help to quit smoking, and support with weight, activity and alcohol. The second is finding disease early, while it is still silent and most treatable, through screening tests and simple measurements such as blood pressure. Neither job depends on you noticing something wrong, which is exactly why it is so easy to put off.

Many of the conditions that shorten American lives give no warning for years. High blood pressure, high cholesterol, prediabetes, early colorectal cancer and early lung cancer usually cause no symptoms at all until they have done considerable damage. By the time you feel unwell, the opportunity for the simplest treatment may have passed. A blood pressure check takes two minutes; a stroke can change the rest of your life. That imbalance is the whole argument for prevention.

Preventive care is also more selective than many people expect. US recommendations, especially those from the US Preventive Services Task Force (USPSTF), an independent panel of experts, only endorse a test when the evidence shows its benefits outweigh its harms for a particular group. That is why there is no routine full-body scan, no yearly chest X-ray for everyone, and no single blood panel that rules out disease. Knowing which tests are recommended for you, and which are not, is part of getting good care.

Your yearly checkup and the Annual Wellness Visit

A regular preventive visit with a primary care provider is the hub that everything else in this guide connects to. It is where your numbers are checked, your risks are reviewed, vaccines and screenings are planned, and problems are picked up before they become emergencies. Having an established relationship with a primary care provider also makes it far easier to get seen quickly when you are ill. If you do not have one, it is worth finding one now, while you are well, rather than when you need one.

If you have Medicare, two visits are designed for prevention. In your first 12 months with Part B, you can have a one-time Welcome to Medicare preventive visit. After you have had Part B for more than 12 months, you are eligible for a yearly Annual Wellness Visit, once every 12 months. It includes a health risk assessment, a review of your medicines, blood pressure and weight measurements, a check of memory and thinking, and a written schedule of the screenings you are due. There is no copay or deductible when the provider accepts assignment.

The Annual Wellness Visit is a planning visit, not a full head-to-toe physical exam. If you bring up a new problem or need a test to investigate a symptom during the same appointment, that part may be billed separately, with the usual cost-sharing. That is not a reason to stay quiet about symptoms, but it helps to know so the bill does not come as a surprise. If you are not on Medicare, most health plans cover a yearly preventive checkup; ask your plan what it includes.

• A list of every medicine, vitamin and supplement you take, with doses
• Your family history, especially heart disease, stroke, diabetes and cancers, and the ages they started
• Dates and results of your last screenings and vaccines, if you have them
• Any home blood pressure readings
• Two or three questions written down in advance

Knowing your numbers

A small set of measurements describes most of the risk you can do something about. Each is silent, each can be measured in minutes, and knowing them turns a vague worry into something you can act on. The American Heart Association groups the most important ones into Life's Essential 8: blood pressure, cholesterol, blood sugar, body weight, physical activity, diet, sleep and nicotine exposure. Write your numbers down, keep them somewhere you will find them, and ask what each one means for you.

Numbers are most useful together. Your doctor can combine age, sex, blood pressure, cholesterol, diabetes status and smoking into an estimate of your 10-year risk of heart attack or stroke. That single figure is often more meaningful than any one result on its own, and it is what guides decisions such as whether a cholesterol-lowering medicine is worth taking. Ask for your estimate and what would change it.

Blood pressure

Normal blood pressure is below 120/80 mm Hg, and high blood pressure is defined as 130/80 mm Hg or higher. All adults 18 and older should be screened: yearly from 40 or if you have risk factors, and every 3 to 5 years if you are 18 to 39 with normal readings and no risk factors. One reading is not enough to diagnose high blood pressure. If yours is raised, you will usually be asked to check it at home with a validated upper-arm monitor and the right cuff size, sitting quietly with your back supported and your arm at heart level, and to record readings over several days.

Blood sugar

Blood sugar is usually measured as HbA1c, which reflects your average over the past two to three months. According to the American Diabetes Association, an HbA1c from 5.7 to 6.4 percent indicates prediabetes, and 6.5 percent or above indicates diabetes. A fasting glucose of 100 to 125 mg/dL indicates prediabetes, and 126 mg/dL or higher on repeat testing indicates diabetes. Prediabetes is common, usually causes no symptoms, and is the stage at which changes to activity, diet and weight make the biggest difference.

Cholesterol and weight

Cholesterol results are reported in mg/dL and include total, LDL, HDL and triglycerides. There is no single target that fits everyone; your doctor interprets them alongside your overall risk. For weight, body mass index is a rough guide, with 25 to 29.9 classed as overweight and 30 or above as obesity, but it does not show where fat is carried. A waist over 40 inches (102 cm) in men or 35 inches (89 cm) in women is linked to higher risk of heart disease and type 2 diabetes, even at a normal weight.

Cancer screening

Cancer screening means testing people who have no symptoms, in order to find cancer early or to find precancerous changes that can be removed before they become cancer. Colorectal and cervical screening are especially valuable for that second reason: removing a polyp or treating abnormal cervical cells prevents cancer from developing at all. For other cancers, screening aims to catch disease at an earlier, more treatable stage.

Every screening test has limits. A normal result does not guarantee you are free of cancer, and cancers can develop between rounds. Screening can also cause harm: false alarms that lead to anxiety and further tests, and overdiagnosis, which means finding slow-growing cancers that would never have caused a problem and then treating them anyway. That is why recommendations are specific about ages and intervals, and why some tests, such as prostate screening, are framed as a personal decision rather than a blanket recommendation.

Most importantly, screening is for people without symptoms. If you notice a breast lump, bleeding between periods or after menopause, a persistent change in bowel habits, blood in your stool or urine, or unexplained weight loss, do not wait for your next screening appointment. See your doctor promptly, and mention it even if your last screening result was normal. When symptoms are present, the tests used are diagnostic rather than screening tests, and they may be billed differently.

• Colorectal cancer: ages 45 to 75, using a stool-based test or a direct visual test such as colonoscopy, at the interval recommended for that test. After 75, decide with your doctor.
• Breast cancer: mammography every 2 years, ages 40 to 74, for women at average risk.
• Cervical cancer: ages 21 to 29, a Pap test every 3 years; ages 30 to 65, a Pap test every 3 years, an HPV test every 5 years, or both together every 5 years.
• Lung cancer: a yearly low-dose CT scan for adults 50 to 80 with a 20 pack-year smoking history who smoke now or quit within the past 15 years.
• Prostate cancer: for men 55 to 69, PSA screening is an individual decision made after discussing benefits and harms with your doctor.

If you are at higher risk

These schedules are for people at average risk. A strong family history, a known inherited gene change, previous abnormal results, inflammatory bowel disease or past radiation to the chest can all mean starting earlier, testing more often or using a different test. Tell your doctor about family history in detail, including which relatives were affected and at what age, because it can change your plan considerably.

Other screenings worth knowing about

Beyond cancer and blood pressure, several other screenings are recommended for specific groups. Most are simple blood tests or questionnaires, and several are needed only once or a few times in a lifetime. They are easy to miss precisely because they are not yearly, which is why a written screening schedule from your doctor is so useful. Ask which of the following apply to you, and note the date each was done.

Screening for depression and anxiety is often done with a short questionnaire at a checkup. It can feel personal, but these conditions are common, treatable and frequently go unrecognized, partly because people assume their symptoms are just stress. Answer honestly; the point is to offer help, not to label you. If you are in crisis at any time, call or text 988 to reach the 988 Suicide & Crisis Lifeline.

• Prediabetes and type 2 diabetes: adults 35 to 70 who have overweight or obesity, and earlier for those with other risk factors.
• Hepatitis C: a one-time test for all adults 18 to 79, and repeat testing for those with ongoing risk.
• HIV: at least once for everyone 15 to 65, and more often for people at increased risk.
• Abdominal aortic aneurysm: a one-time ultrasound for men 65 to 75 who have ever smoked.
• Osteoporosis: bone density testing for women 65 and older, and for younger postmenopausal women at increased risk.
• Depression in adults, and anxiety in adults under 65, as part of routine care.
• Unhealthy alcohol use, with brief counseling where it would help.

Vaccines are not only for children

Many adults assume vaccination ends in childhood, but several of the most useful vaccines are recommended later in life, and protection from some childhood vaccines fades. A yearly flu vaccine is recommended for nearly everyone 6 months and older. A tetanus and diphtheria booster, either Td or Tdap, is recommended every 10 years, and Tdap is also recommended in each pregnancy. Two doses of the recombinant shingles vaccine are recommended from age 50, and earlier for some adults with weakened immune systems.

Pneumococcal vaccines, which protect against a common cause of pneumonia, and RSV vaccines are recommended for older adults and for some younger adults with certain health conditions. Eligibility for these, and for COVID-19 vaccines, has changed several times in recent years and may differ depending on which body's recommendation you follow, so ask your doctor or pharmacist what applies to you now rather than relying on what you heard a few years ago. If you are unsure whether you had two doses of MMR, or whether you were vaccinated against hepatitis B, ask about checking your records or immunity.

Pharmacies give many adult vaccines, often without an appointment, and most insurance plans cover routinely recommended vaccines without a copay when you use an in-network provider. Before any vaccine, tell the person giving it about previous serious allergic reactions, a weakened immune system, pregnancy or a bleeding disorder. If you are traveling abroad, plan several weeks ahead, because some travel vaccines need more than one dose or time to take effect.

The everyday habits that matter most

Screening finds problems; habits prevent them. The evidence points consistently to a short list of habits that have the largest effect on heart disease, stroke, type 2 diabetes and many cancers. None of them needs to be perfect. Moving from doing nothing to doing something usually brings the biggest gain, which is encouraging if you are starting from a low base.

Not smoking is the most important. Smoking is the single largest preventable cause of disease and death in the US, and quitting at any age helps, with heart attack risk falling sharply within a year or two. Willpower alone has the lowest success rate of any method. Combining a quit-smoking medicine with counseling works best: FDA-approved options include nicotine replacement, varenicline and bupropion, and using a nicotine patch together with a faster-acting form such as gum or lozenges works better than either alone. Free coaching is available through 1-800-QUIT-NOW (1-800-784-8669).

For activity, US guidelines recommend at least 150 minutes a week of moderate activity, such as brisk walking, plus muscle-strengthening activity on at least 2 days. For food, the Dietary Guidelines for Americans advise keeping sodium under 2,300 mg a day and added sugars under 10 percent of calories, and building meals around vegetables, fruits, whole grains, beans and lean proteins. Adults need at least 7 hours of sleep a night for good health. Each of these also helps with blood pressure, blood sugar, cholesterol and weight at the same time.

Alcohol

The Dietary Guidelines for Americans, 2020 to 2025, advise that adults who drink limit intake to 2 drinks or fewer a day for men and 1 drink or fewer a day for women, on days when alcohol is consumed, and that drinking less is better for health than drinking more. A US standard drink contains 14 g of pure alcohol: 12 fl oz of regular beer at 5 percent, 5 fl oz of wine at 12 percent, or 1.5 fl oz of spirits at 40 percent. Many drinks poured at home or served in bars are larger than this. Nobody should start drinking for health reasons, and there is no known safe amount in pregnancy. If you drink heavily every day, do not stop suddenly without medical advice, because withdrawal can be dangerous. The SAMHSA National Helpline, 1-800-662-4357, is free, confidential and open 24 hours.

Preventive care at different stages of life

Children and teens have their own schedule of well-child visits, which the American Academy of Pediatrics sets out from the first days of life through adolescence. These visits track growth and development, check vision and hearing, cover vaccines, and give parents a regular chance to ask questions. In the teen years they also include private time with the clinician to discuss mood, substance use, relationships and safety. Regular dental checkups are part of preventive care at every age.

In pregnancy, prenatal care is preventive care. Early and regular visits allow screening for conditions such as gestational diabetes and high blood pressure, which can harm both parent and baby without causing symptoms. Vaccines recommended during pregnancy help protect the newborn in the first months of life. If you are planning a pregnancy, a visit beforehand is worthwhile to review medicines, vaccines and folic acid.

For older adults, prevention shifts toward keeping independence. Falls are a major threat, and strength and balance exercise, a medicine review and a home safety check all reduce the risk. Vision and hearing problems are easy to dismiss but affect safety, mood and memory. The Annual Wellness Visit includes a check of memory and thinking. After a certain age or in poor health, some screenings stop being worthwhile, and it is reasonable to ask your doctor whether a test still makes sense for you.

If you already have a long-term condition

Living with diabetes, heart disease, kidney disease, COPD or another long-term condition does not mean preventive care is beside the point. It usually means more of it: additional vaccines, more frequent checks of blood pressure and cholesterol, eye and foot exams in diabetes, and kidney tests. Make sure condition-specific checks and general screenings are both on your plan, because other doctors you see sometimes assume your primary care provider is handling the general ones, and the reverse.

Costs, coverage and access in the US

Under the Affordable Care Act, most private health plans must cover a set of preventive services without charging a copay, coinsurance or deductible, as long as you use an in-network provider. These include screenings and counseling recommended by the USPSTF, routinely recommended vaccines, and preventive care for women and children. Plans that existed before the law and kept their old terms, known as grandfathered plans, may not have to follow these rules, so check your plan documents if you are unsure.

Free does not always mean free in practice. If a screening finds something and you need a follow-up test, if you discuss a new problem during a preventive visit, or if you go out of network, you may face charges. Before booking, ask your plan and the provider how the visit will be billed, and ask how follow-up testing is covered if a screening result is abnormal. Keep the explanation of benefits from your insurer and query anything labeled preventive that you were charged for.

Medicare covers the Annual Wellness Visit and many screenings and vaccines, often with no cost to you when the provider accepts assignment. Medicaid covers preventive services, with details varying by state. If you are uninsured, federally funded community health centers offer care on a sliding fee scale based on income, and many health departments offer low-cost vaccines and screenings. Pharmacies often provide vaccines and blood pressure checks, and you can review plan options on HealthCare.gov.

Getting the most from your appointments

Preventive care only works if you understand and act on it, and much health information is harder to follow than it should be. Three questions help at any appointment involving a choice: What are my options? What are the possible benefits and risks? How do I decide? Choosing together with your clinician, based on the evidence and what matters to you, is called shared decision making, and it is how decisions such as prostate screening or starting a cholesterol medicine are supposed to be made.

Before you leave, repeat back what you understood, a technique clinicians call teach-back. It is the quickest way to catch misunderstandings. Confirm what happens next, when and how you will get results, what symptoms should bring you back sooner, and who to contact if things change. Do not assume no news is good news; if you have not heard about a result when you expected to, call. You can ask for information in writing, in another format, or with an interpreter, and you can bring someone with you.

Use the right service for the problem. Call 911 for emergencies. Use urgent care for problems that need prompt attention but are not life-threatening. Use your doctor's office, an after-hours line or a nurse line when you are not sure. For a possible poisoning in someone who is awake and breathing, call Poison Control at 1-800-222-1222. Emergency rooms must evaluate you regardless of ability to pay, so never delay emergency care over cost.

Myths and the guidance behind them

A few persistent beliefs keep people away from useful care or toward care that does not help. Clearing them up is often the first step to a sensible plan. Most of these myths come from a reasonable instinct, such as wanting certainty or not wanting to bother a busy doctor, applied in a way that the evidence does not support.

Be especially wary of screening packages sold directly to the public, such as whole-body scans or large panels of blood tests offered without a clinician who knows your history. They are not part of US screening recommendations for people at average risk, they are usually not covered by insurance, and they often turn up incidental findings that lead to further tests, cost and worry without improving health. If a test is not on your written screening schedule, ask your doctor what question it would answer before paying for it.

• Myth: I feel fine, so I do not need a checkup. Guidance: the conditions prevention targets are usually silent; feeling well is the reason to go.
• Myth: more tests are always better. Guidance: tests are recommended only where benefits outweigh harms; unnecessary tests bring false alarms and overtreatment.
• Myth: a normal screening result means I am covered until next time. Guidance: report new symptoms whenever they appear.
• Myth: vaccines are for children. Guidance: flu, tetanus, shingles, pneumococcal and RSV vaccines are all recommended for adults at different ages.
• Myth: a normal weight means low risk. Guidance: blood pressure, blood sugar, cholesterol and waist size can all be raised at a normal weight.
• Myth: it is too late to quit smoking. Guidance: quitting at any age reduces risk, and support makes success far more likely.
• Myth: preventive visits always cost money. Guidance: most plans cover recommended preventive services without cost-sharing in network.

A practical yearly plan

The simplest way to keep on top of prevention is to tie it to a fixed point in the year, such as your birthday, and treat it like any other annual task. Keep a single page or a note on your phone with your numbers, the dates of your screenings and vaccines, and when each is next due. Bring it to every appointment and update it afterward. If you miss a screening, reschedule it rather than waiting for a reminder that may not come.

Between visits, the habits do the work. Small, consistent changes to activity, sleep, alcohol and food add up across a year in a way that occasional bursts of effort do not. If you check your blood pressure at home, do it at the same time of day and keep a log. Pick one habit at a time to work on, such as a daily walk or an earlier bedtime, and give it a few weeks to settle before adding the next.

• Birthday month: book your yearly checkup or Annual Wellness Visit and update your list of medicines and family history.
• At the visit: record your blood pressure, weight, waist and any blood results, ask for your 10-year cardiovascular risk, and leave with a written screening schedule.
• Fall: get your flu vaccine and ask whether any other vaccines are due.
• Throughout the year: complete any home stool test promptly, attend scheduled mammograms, Pap or HPV tests and scans, and follow up on any abnormal result.
• Every week: aim for 150 minutes of moderate activity and 2 days of strength work, and keep alcohol within guidance.
• Any time: report new or unusual symptoms without waiting for your next checkup.

Every guide in this topic

• Annual Wellness Visit: What the Evidence Actually Says
• The Evidence on Cancer Screening Recommendations, Without the Hype
• What the Guidance Really Says About Blood Pressure Checks
• The Evidence on Adult Vaccination, Without the Hype
• Knowing Your Numbers: Sorting the Evidence From the Noise
• The Evidence on Stopping Smoking, Without the Hype
• Alcohol Reduction: What the Evidence Actually Says
• Choosing the Right Care: What Published Guidance Supports
• The Evidence on Health Literacy, Without the Hype
• The Evidence on Occupational Health, Without the Hype

Frequently asked questions

Is the Medicare Annual Wellness Visit the same as a physical?

No. The Annual Wellness Visit is a prevention-planning visit: a health risk assessment, medicine review, blood pressure and weight, a memory check and a personalized screening schedule. It is not a full head-to-toe exam. If you discuss a new problem or need tests for symptoms during the same visit, that part may be billed separately with the usual cost-sharing.

How often do I need a checkup if I feel healthy?

A yearly preventive visit is a sensible routine for most adults, and Medicare covers an Annual Wellness Visit once every 12 months. What matters most is that the specific screenings, measurements and vaccines due for your age and risk get done on time. Ask your doctor for a written schedule so you know what is due and when.

Will my preventive care really be free?

Under the Affordable Care Act, most plans cover recommended preventive services without a copay or deductible when you use an in-network provider. You may still be charged if you discuss a new problem during the visit, need follow-up tests after an abnormal result, see an out-of-network provider, or have a grandfathered plan. Ask your insurer and provider beforehand.

Is a stool test as good as a colonoscopy for colorectal screening?

Both are recommended options for adults 45 to 75 at average risk. Stool tests are done at home and repeated more often; colonoscopy is done less often and can remove polyps during the same procedure. The best test is the one you will actually complete. A positive stool test needs a follow-up colonoscopy, so do not ignore it.

Should I have a PSA test for prostate cancer?

For men 55 to 69, PSA screening is an individual decision. It can find some cancers earlier, but it also leads to false alarms and to treatment of cancers that would never have caused harm, with possible side effects. Talk it through with your doctor, including your family history and personal preferences, before deciding.

Which vaccines do adults need?

A yearly flu vaccine, a Td or Tdap booster every 10 years, and two doses of shingles vaccine from age 50 are recommended for most adults. Pneumococcal and RSV vaccines are recommended for older adults and some people with health conditions, and eligibility has changed recently. Ask your doctor or pharmacist to review your record and tell you what is due now.

Can I check my blood pressure at home instead of at the doctor's office?

Home readings are very useful and are often more representative than a single office reading. Use a validated upper-arm monitor with the correct cuff size, sit quietly for a few minutes first, and record readings over several days. Share them with your doctor. If a reading is 180/120 or higher, check again after a minute and contact your doctor right away if it stays that high.

What is the best way to quit smoking?

Combining a quit-smoking medicine with counseling works far better than willpower alone. FDA-approved options include nicotine replacement, varenicline and bupropion, and a nicotine patch plus a fast-acting form works better than either alone. Call 1-800-QUIT-NOW for free coaching. Talk to your doctor or pharmacist first if you are pregnant or take medicines affected by smoking.

I do not have health insurance. Where can I get preventive care?

Federally funded community health centers offer primary and preventive care on a sliding fee scale based on income. Local health departments often provide low-cost vaccines and some screenings, and many pharmacies offer vaccines and blood pressure checks. You may also qualify for Medicaid or subsidized coverage; check HealthCare.gov or your state Medicaid office.

Do I still need screening if I am older or have other health problems?

It depends. Some screenings, such as colorectal and breast, have upper age limits beyond which the decision becomes individual, because the benefit falls as health and life expectancy change. Other checks, such as blood pressure, vaccines and fall prevention, matter more with age. Ask your doctor which tests are still worthwhile for you specifically.

When to speak to a doctor

Do not wait for a preventive visit if you have symptoms. See your doctor promptly for a new lump, unexplained weight loss, a cough lasting more than three weeks, blood in your urine or stool, a persistent change in bowel habits, bleeding between periods or after menopause, or excessive thirst and frequent urination. If a repeated blood pressure reading is 180/120 or higher, contact your doctor right away. Call 911 for chest pain lasting more than a few minutes, sudden weakness or numbness on one side, facial drooping, difficulty speaking, severe breathlessness or heavy bleeding with dizziness. For a possible poisoning, call Poison Control at 1-800-222-1222, and if you are having thoughts of suicide, call or text 988.

Where this comes from

• Medicare.gov — Yearly "Wellness" visits
• HealthCare.gov — Preventive care benefits for adults
• US Preventive Services Task Force — Colorectal Cancer: Screening
• US Preventive Services Task Force — Breast Cancer: Screening
• US Preventive Services Task Force — Cervical Cancer: Screening
• US Preventive Services Task Force — Lung Cancer: Screening
• CDC — Adult Immunization Schedule by Age
• American Heart Association — Life's Essential 8
• American Diabetes Association — Standards of Care in Diabetes
• Dietary Guidelines for Americans — Dietary Guidelines for Americans, 2020-2025

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.