Self-pay longevity in Germany

Statutory insurance (GKV) pays for basic screening such as the Check-up 35, cancer screening and vaccinations. It also pays for tests and drugs when there is a medical reason, but not for longevity extras. A few of the free checks serve longevity goals too, which makes them the first thing to use before you spend your own money.

What everyone gets at set ages

As of October 2026, the prevention catalogue covers these checks:

• Health check-up (Check-up 35) every 3 years from 35: your doctor asks about your history, takes your blood pressure, measures your blood fats and your blood sugar after an overnight fast, and checks a urine sample with a dipstick, and once you also get a hepatitis B and C test.^{[14, 26]} The blood-fat test (lipid profile) covers total cholesterol, the LDL and HDL forms of cholesterol, and triglycerides, another fat in your blood.^{[14, 26]} Between 18 and 34 you get one check-up, with blood tests only if you have risk factors.^[26] What the check-up leaves out is ApoB and Lp(a), two further blood-fat markers, and HbA1c, a measure of your average blood sugar. The Check-up 35 guide has the details.
• Skin cancer screening every 2 years from 35.^[25]
• Colorectal cancer screening from 50: an iFOBT stool test (it checks for hidden blood in your stool) every 2 years, or two screening colonoscopies 10 years apart. The G-BA, the body that decides what statutory insurance covers, made these rules the same for women and men from 1 April 2025.^[1]
• Breast cancer screening from 50 to 75: mammography every 2 years. The upper age used to be 69, and women aged 70 to 75 have been included since 1 July 2024.^{[24, 58]}
• Breast cancer screening from 45 to 49: until August 2027 the Kasse does not pay for routine screening in this age group. From 1 August 2027 it becomes a GKV benefit, as long as the Federal Ministry of Health reviews the decision and raises no objection.^[24] From then on you can book an appointment yourself through your state's central screening office (Zentrale Stelle), and personal invitations are expected from about January 2028.^[24] The change came in two steps: an amendment to Germany's breast screening ordinance (Brustkrebs-Früherkennungs-Verordnung) has allowed mammography from 45 since 5 March 2026,^[8] and the G-BA, which began its deliberations in April 2026,^[19] lowered the screening age to 45 on 15 October 2026.^[24]
• Lung cancer screening (new since April 2026): a low-dose CT every 12 months for current and former heavy smokers aged 50 to 75. You need at least 25 years of smoking and at least 15 pack-years (one pack-year means 20 cigarettes a day for a year). Short smoking breaks still count towards the 25 years, but after a break of ten years or more the years before it no longer count, so someone who quit long ago no longer qualifies.^{[9, 53]} A participating GP, internist or occupational physician checks whether you qualify, talks you through benefit and harm, and refers you to an authorised radiology practice.^[9] After an unremarkable result you are entitled to the next scan after 12 months.^[9] It is the only CT that German radiation law allows as screening, which makes it the only screening CT the GKV pays for.^[35]
• Cervical cancer screening
• Prostate exam from 45
• Vaccinations as recommended by STIKO, Germany's standing vaccination committee

Two of these offers may change, because on 15 October 2026 the G-BA opened a review of skin cancer screening and of the check-up.^[25] Skin cancer screening could become risk-based or move to a different interval, while the check-up could shift its focus to cardiovascular disease. The review is due by the end of 2027, and until it decides, the current rules apply.^[25]

What you get with a medical reason

Beyond that fixed catalogue, the Kasse pays for tests and drugs whenever your doctor has a medical reason:

• Bone density DXA when concrete findings, such as a fracture without adequate trauma, mean your doctor is considering osteoporosis medication, plus repeat scans to check that treatment^[29]
• Single blood tests such as ApoB, Lp(a) or hormones, when your doctor has a medical reason for them
• Targeted imaging, such as an MRI your doctor needs to explain symptoms
• Blood pressure drugs for confirmed hypertension
• Statins if you already have cardiovascular disease or a high risk (a 10-year event risk above 10 percent), and in a few special cases such as familial hypercholesterolaemia; a mildly raised risk alone is not enough^[18]
• Metformin for type 2 diabetes
• HRT (hormone therapy) when menopause calls for it
• GLP-1 agonists for diabetes

What you pay for yourself

Without a medical reason, the GKV does not cover:

• Expanded longevity blood panels, the omega-3 index or a microbiome analysis
• Biological or epigenetic age tests (these read the chemical tags on your DNA, which shift as you get older)
• Whole-body MRI as routine screening
• A coronary calcium score booked just to check, which is not even permitted as pure screening^[33]; with suspected coronary disease it is part of a Kasse work-up instead^[27]
• VO2 max tests, which measure the most oxygen your body can use during hard exercise, outside a medical indication such as heart or lung disease
• CGM (a continuous glucose monitor) without diabetes
• GLP-1 drugs for weight loss, which the law excludes as lifestyle drugs^[2]
• Longevity consultations at private practices
• IV therapies

Everything on that last list has a price, and for the same test that price can differ a lot between a budget lab and a premium practice.

Outside the Kasse catalogue, a full longevity blood panel costs roughly €150 to €450 (as of October 2026). A check-up package at a longevity clinic costs €1,500 to €5,000, and a whole-body MRI sits in between at €800 to €2,500. Every practice bundles its own package, so a longevity check-up is less a fixed product than a shopping basket. The tables below list its building blocks one by one.

The prices are typical ranges from published price lists of German labs and practices. They are wide on purpose, because the low end is a budget lab and the high end a premium private practice for the same test. Direct-to-consumer kits can come in lower still: one mail-order lab charges about €124 for a basic microbiome test and €66 for a heavy-metal test.^{[51, 52]}

In the tables, "IGeL" (Individuelle Gesundheitsleistungen) means a self-pay service that a practice sells on top of what the Kasse covers. The column "Does GKV pay?" shows what happens when your doctor has not documented a medical reason.

Lab tests are the cheapest building blocks, and the Kasse pays for only a few of them, each time only with a medical reason:

Heart, lung and imaging tests cost more, and two of them use X-rays, which limits who may have them at all:

Cardiac MRI is the odd one out in that table. Outpatient cardiac MRI is not in the GKV fee schedule, so some Kassen paid for it only through special contracts^[50] According to one specialist practice, TK ended those contracts nationwide in spring 2026.^[50] Since 1 April 2026 the same practice can no longer examine Barmer patients either.^[50] Check your current cover with your Kasse before booking (as of October 2026).

Therapies are sold per session, so their cost grows with every visit:

Visits, packages and subscriptions make up the rest of the basket:

Price says little about value, even at the cheap end. IGeL-Monitor is the independent rating service of the Medizinischer Dienst. It rates two cheap checks as "leaning negative", a carotid ultrasound for stroke prevention and a screening ECG in people without symptoms.^{[21, 22]} It rates screening for vitamin D deficiency, or for diabetes by HbA1c, as "unclear".^{[39, 40]} At the top of the price range, whole-body MRI has no proven benefit for people without symptoms or risk factors.^[13]

DXA and calcium score: allowed only with a medical reason

Two items in these tables use X-rays: DXA and the calcium score, which is a CT scan. For those, as for any other CT, the first question is whether the scan is allowed at all, and only then who pays.^[31] German law requires a doctor with radiation-protection training to confirm first that the benefit outweighs the risk, which is called a justifying indication (rechtfertigende Indikation).^[31]

That rule settles the body-fat question. The German Commission on Radiological Protection (SSK) has stated that a DXA without a medical indication, for example to track body fat or muscle, is not permissible.^[30] Even to screen for osteoporosis, it considers DXA not justified without additional risk factors.^[30] So a body-fat DXA "just to check" is not a legitimate self-pay purchase, even if some practices advertise it.

A calcium score booked just to check runs into the same wall. German radiation law allows X-ray screening of people without symptoms only for approved programmes.^[32] Coronary CT is not one of them. The Federal Office for Radiation Protection (BfS) has looked at it every year since 2024 and keeps deferring it.^[34] IGeL-Monitor states that CT screening for coronary heart disease without symptoms or a concrete suspicion is not legally permitted, even though some practices offer it.^[33] Because every scan needs a radiologist's justified indication,^[31] expect questions about symptoms and risk factors, and expect to be turned away if there is no medical question.

The legitimate route to a calcium score runs through the Kasse, as part of a CT scan of the heart's arteries called CT coronary angiography (CCTA).^[27] Before the Kasse pays for one, a doctor estimates your pretest probability, which is the chance that you have chronic coronary artery disease before any test. If that estimate is 15 percent or more and the doctor still suspects the disease, the Kasse pays for a CCTA.^[27] The calcium score is then taken as part of that work-up.^[27] It also pays when a CCTA is medically necessary to rule the disease out before heart surgery that is already planned.^[27] The route is fairly new. The G-BA added CCTA to the GKV catalogue on 18 January 2024,^[17] and practices have been able to bill it since 1 January 2025.^[28]

Where a calcium score is medically justified, it can sharpen an unclear heart risk. The European guideline says it "may be considered" for people at low or moderate risk.^[37] The US Preventive Services Task Force is more cautious. In its view the evidence is insufficient to judge whether adding the score to a standard risk assessment does more good than harm.^[36] Even the legal version is therefore a tool for one open question, not a routine check you repeat.

In our view, switching to private insurance (PKV) for longevity alone is rarely worth it. The decision rests on decades of premiums, not on a few check-ups. A private insurer pays what your contract says, which means medically necessary treatment and statutory screening programmes.^[15] Because contracts vary a lot, check how each PKV tariff you compare handles these points:

• Expanded lab tests on a physician's order
• Non-physician services, such as a Heilpraktiker (the German non-medical practitioner), and to what extent
• Longer prevention appointments
• Extra check-ups or imaging without a medical reason, which are paid only if the tariff's prevention benefits explicitly cover them

Supplementary plans for GKV members

If you stay in the GKV, a supplementary plan (Zusatzversicherung) is the cheaper way to get some of these extras, mainly Heilpraktiker services and some prevention. Three types are common. Outpatient plans often cover Heilpraktiker services and expanded prevention, Heilpraktiker plans cover only those services, and prevention plans add to what the GKV pays for prevention. Depending on the tariff, premiums run €10 to €50 a month and refunds 50 to 80 percent (a rough market range, as of October 2026). Those refunds are often capped, with caps that grow over the first years.

Hallesche's outpatient tariff AE.3 shows how such caps work. It pays 50% of Heilpraktiker costs, up to €260 of invoices in the first calendar year, €520 in the second and €780 from the third.^[49] Münchener Verein and Barmenia also sell Heilpraktiker and outpatient top-ups, so compare the current tariff's percentage, caps and premium rather than the insurer's name.

Before you sign, check four things in the fine print:

• The waiting period: the law caps the general one at three months, with up to eight months only for items such as dental treatment or psychotherapy^[59]
• The yearly caps
• The excluded methods, for example whether bioresonance is covered
• Which labs are in-network

The excluded methods are where people get caught out most, so a plan is only worth its premium if the methods you actually want are on its list.

For most people, about €500 to €1,000 a year covers what we think is worth paying for out of pocket, whatever their insurance. That buys a few targeted blood tests, a fitness test and a subscription wearable, on top of the free GKV screening. Whole-body MRI belongs only in a surveillance plan for an inherited cancer syndrome, and every other service is worth checking against an independent rating before you pay.

Check IGeL-Monitor first

That independent rating comes from IGeL-Monitor, which the Medizinischer Dienst Bund runs at igel-monitor.de and which weighs benefit against harm for self-pay services. Of the 61 services it had rated by 18 June 2026, not one earned a clear positive, and only three came out leaning positive.^[3] Each rating covers one service for one purpose, so look up the exact use you would be paying for. Hyperbaric oxygen (HBOT), for example, is rated "unclear" specifically for Long-COVID.^[54] Some popular offers have no entry at all: the A-Z index lists no NAD+ IV drips, no Myers cocktail and no high-dose vitamin C IV outside cancer care.^[57] A missing rating is not a green light either, because it only means IGeL-Monitor has not assessed the service.

A sensible order

Start with the screening your statutory insurance already covers, then add spending in four tiers that run from free basics to experimental extras. Those free offers are German ones, and since they differ in Austria and Switzerland, check with your insurer there what basic cover includes.

Tier 1. Baseline (free or already paid by the GKV)

• Use the GKV prevention you are entitled to.
• Bone density: if you have had a fracture without adequate trauma, such as after a minor fall, ask your doctor, because the DXA can then be a Kasse service.^[29]
• No smoking, little alcohol.
• Daily movement and strength training 2 to 3 times a week.
• Track strength with a grip strength test; many gyms and practices have a dynamometer (a hand-grip meter).
• 7 to 8 hours of sleep.

Tier 2. Low effort, good value (€250 to €650 a year, plus a wearable)

• Targeted blood tests instead of a big yearly panel (see below).
• A VO2 max test every year or two, as a practical suggestion, since there is no trial-based interval.
• A wearable (Whoop, Oura, Garmin).

Tier 1 plus Tier 2 comes to about €250 to €650 a year. That pays for targeted blood tests (at most €150 to €450, the price of a full panel) and a VO2 max test at a sports medicine centre (€100 to €200). A subscription wearable such as Whoop adds €240 to €360 a year (Garmin needs no subscription), which brings the total to about €500 to €1,000 a year. That figure leaves out the wearable's purchase price and any Tier 3 visit.

Those targeted blood tests are deliberately few. Lp(a) is largely set by your genes, and the European guideline suggests measuring it at least once in your life.^[37] ApoB or a lipid profile and HbA1c are useful when they could change a decision, for example about a statin. Routine vitamin D testing without a medical reason is not recommended.^[38] IGeL-Monitor is no more enthusiastic, rating screening for vitamin D deficiency, B12 deficiency and diabetes by HbA1c as "unclear".^{[39, 40, 41]} How often you repeat a test is your doctor's call, based on your earlier results.

Tier 3. Medium effort (roughly €200 to €1,000 a year: one practice visit, plus an epigenetic test if you want one)

• A yearly visit at a longevity private practice; a first visit costs €200 to €500.
• An epigenetic age test only if you are curious. Researchers argue that these clocks work for research on groups of people but are not reliable enough to guide decisions for one person, and no interval is recommended.^[42]
• A calcium score only if your doctor sees a medical reason and the result would change a treatment decision (the legal side is in the cost section).
• A documented vitamin deficiency does not belong in this tier: it is a medical indication for your doctor to treat, not a longevity add-on.

Tier 4. Experimental and high-cost, mostly not worth it for healthy people (often €1,500 and up a year)

• Whole-body MRI only inside a surveillance plan for an inherited cancer syndrome (see the risk rule below).
• A CGM (continuous glucose monitor) without diabetes.
• NAD+ infusions, which are experimental: they have no approved use for longevity, and human data so far are small studies of what happens to blood levels during an infusion, not health outcomes.^[44] IGeL-Monitor has not rated them.^[57]
• Off-label drugs such as rapamycin, also experimental. Rapamycin (sirolimus) is prescription-only, and as a tablet (Rapamune) it is approved in the EU to prevent kidney-transplant rejection and for the rare lung disease LAM.^[43] Longevity use is off-label and needs a doctor who monitors you (see the rapamycin guide).

Where your next euro goes, by budget

If you would rather start from a budget than from the tiers, this table sorts the same steps by what you want to spend in a year:

The two free tests in the €0 row need no equipment. In the sit-rise test you get up off the floor without using your hands. In middle-aged and older adults, low scores were linked to a higher risk of dying.^[7] The Rockport walk test estimates your VO2 max from a brisk 1-mile walk.

The two age tests in the €1,500 row measure different things. TruAge Complete is an epigenetic test that reads DNA methylation, while GlycanAge measures sugar chains on your antibodies and so is not an epigenetic test at all. Their prices differ in the fine print too. EU import VAT comes on top of TruAge Complete, whereas GlycanAge's lab is in Zagreb, Croatia, so its shipping stays inside the EU. Whether the physician visit in the same row is worth its roughly €300 depends on what you want from a doctor.

The physician route

If you want prescriptions (rapamycin off-label, HRT, GLP-1 on indication) and lifestyle coaching in one place, a physician is the right stop rather than a Heilpraktiker. All of these drugs are prescription-only, and GLP-1 drugs for weight loss are not paid by the Kasse.^[2] Who pays for the visit itself depends on the practice. In a practice approved for statutory care (Kassenzulassung), standard services run on your insurance card.^[48] Only the longevity consultation is billed as IGeL, at €200 to €500 for a first visit, and in a purely private practice you pay for everything yourself.^[48] Ask before you book.

To find such a doctor, look for an extra qualification on top of their specialty, called a Zusatzbezeichnung, in naturopathy (Naturheilverfahren) or nutritional medicine (Ernährungsmedizin). Preventive medicine (Präventivmedizin) sounds similar, but it is only a training course a doctor has completed (curricular Fortbildung), not a formal extra qualification. The Heilpraktiker longevity guide shows how to search the medical chambers' doctor finder (Ärztekammer-Suche) and arzt-auskunft.de, and what a typical first visit looks like.

Whole-body MRI: a risk-based rule

A doctor is also the right first stop for the most expensive item on the list, because whether whole-body MRI makes sense depends on your personal risk. For people without symptoms or risk factors, the American College of Radiology finds no documented evidence that whole-body screening helps them live longer.^[13] IGeL-Monitor has not rated it as a preventive screen. The closest entries in its A-Z index are breast MRI for cancer screening, rated "unclear",^[55] and MRI to detect Alzheimer's early, rated "leaning negative".^[56] The whole-body MRI screening guide goes deeper on the trade-offs.

The one clear case is Li-Fraumeni syndrome, an inborn change in the TP53 gene that is usually inherited but in some people new.^[45] For this syndrome a yearly whole-body MRI is part of the Toronto Protocol, its surveillance plan, which rests on an observational cohort followed for 11 years.^[4] Two other situations often get lumped in with it, but they call for something else first:

• A strong family history of cancer, for example several relatives with breast or ovarian cancer, or one diagnosed very young: start with genetic counselling. For breast and ovarian cancer, the German S3 guideline lists concrete criteria for offering a gene test.^[6] One of them is two women in one line of the family with breast cancer, one of them before 50.^[6] Whole-body MRI only makes sense if counselling confirms a syndrome whose surveillance plan includes it.
• Neurological symptoms belong with a doctor, who decides whether you need targeted imaging of the brain or spine; that is then a Kasse service, not a whole-body scan. Sudden weakness, numbness, a drooping face, or speech or vision problems are an emergency: call 112.^[46]

Women with a harmful BRCA1/2 variant do not need whole-body MRI for standard surveillance. These inherited disease-causing variants in the BRCA1 or BRCA2 genes raise the risk of breast and ovarian cancer. The recommended plan is a yearly breast MRI plus mammography, along with steps that lower ovarian cancer risk.^[5] The US NCCN guideline on hereditary breast and ovarian cancer starts mammography at 30.^[5] In Germany, intensified screening with MRI and ultrasound, plus mammography every two years from 40, runs through the centres of the German HBOC consortium. The S3 guideline wants it done only within this evaluated programme, because there is no direct proof yet that it lowers deaths, while false alarms do rise.^{[6, 12]}

For everyone else, the ACR warns that such scans turn up many non-specific findings.^[13] Those findings do not improve health but lead to unnecessary follow-up tests, procedures and costs.^[13] When your real risk is low, that downside likely outweighs the upside, and in our view the money does more good elsewhere. If you are 35 or older, a natural first step is the Check-up 35 at your GP. There you can ask which extra blood test would change a decision, given your results.