health · 7 min read
Inside an Annual Physical, Plus the Screenings That Start at 40, 45 and 50
A yearly checkup covers vitals, history and screenings by age, and Medicare's wellness visit follows its own rules.
By AmpleGuide Editors · Updated October 2026
You’ve booked the yearly checkup and now you’re wondering what will actually happen in that room. Will they draw blood? Which tests are you due for at your age, and will any of it show up on a bill?
Most of the answers trace back to one group, the U.S. Preventive Services Task Force. It’s a panel of medical experts appointed by the Secretary of Health and Human Services, and its letter grades decide which screenings your insurer has to cover.
What gets checked at an annual physical?
Most physicals start with your blood pressure, weight and pulse, followed by questions about your health history, your family’s health history and every medication you take.
After that, your clinician usually listens to your heart and lungs. Expect questions about sleep, mood, alcohol and smoking too.
Blood pressure is the check with the firmest rule behind it. In its 2021 recommendation, the Task Force gave screening for adults 18 and older an A grade, its highest. It suggests a reading every year once you’re 40, or earlier if you’re at increased risk, and every 3 to 5 years for adults 18 to 39 who aren’t.
The medication review deserves more of your time than the weigh-in. Bring the vitamins and over-the-counter pills too, since your clinician can only check what you mention.
Will they automatically draw blood?
Blood tests at a checkup usually depend on your age and your risk, so a healthy 30-year-old may leave without a lab order while someone older gets one. The Task Force recommends a few specific blood tests and leaves the rest to you and your clinician.
Two are worth knowing. Since 2021, the Task Force has recommended screening for prediabetes and type 2 diabetes in adults 35 to 70 who have overweight or obesity, down from a starting age of 40. It says testing every 3 years may be reasonable when your results come back normal.
The other is a one-time hepatitis C test for adults 18 to 79, from a 2020 recommendation. “Most adults need to be screened only once,” the Task Force writes, though people with ongoing risk get tested again.
A full blood panel every year is a habit at some offices, with no Task Force grade behind it. If you’d like to know why a test is on your lab slip, it’s fine to ask.
Which checkup services are free?
Under the Affordable Care Act, most private health plans must cover services the Task Force grades A or B with no copay or coinsurance, as long as you see an in-network provider.
HealthCare.gov adds a plain caveat that “$0 cost isn’t guaranteed in all cases,” so a test outside that list, or a visit that turns to a new problem, can still cost you something.
That rule survived a real challenge. On June 27, 2025, the Supreme Court ruled 6 to 3 in Kennedy v. Braidwood Management that Task Force members are properly appointed by the health secretary, who can remove them and review their recommendations before they take effect.
Which screenings start at 40, 45 and 50?
At 40, the Task Force adds a mammogram every 2 years for women, at 45 colorectal cancer screening begins for everyone, and at 50 lung screening opens to people with a long smoking history.
Each of those ages moved in the last few years. The breast cancer recommendation from April 2024 covers women 40 to 74, where the 2016 version had left screening in your 40s as an individual choice. The colorectal recommendation from May 2021 lowered the starting age from 50 to 45 and runs to 75, with several test types and intervals to choose from.
Lung screening is the narrowest. The 2021 recommendation calls for a yearly low-dose CT scan for adults 50 to 80 with a 20 pack-year history who still smoke or quit within the past 15 years. A pack-year is one pack a day for one year, so a pack a day for 20 years counts, and so do two packs a day for 10.
| Screening | Who it’s for | Ages | How often | Current recommendation |
|---|---|---|---|---|
| Blood pressure | All adults | 18 and up | Yearly from 40; every 3 to 5 years at 18 to 39 if not at increased risk | 2021 |
| Hepatitis C | All adults | 18 to 79 | Once for most adults | 2020 |
| Cervical cancer | Women | 21 to 65 | Every 3 years, or every 5 years with HPV testing from 30 | 2018 |
| Prediabetes and type 2 diabetes | Adults with overweight or obesity | 35 to 70 | Every 3 years may be reasonable after normal results | 2021 |
| Breast cancer (mammogram) | Women | 40 to 74 | Every 2 years | 2024 |
| Colorectal cancer | All adults | 45 to 75 | Depends on the test | 2021 |
| Lung cancer (low-dose CT) | 20 pack-years, smoking now or quit within 15 years | 50 to 80 | Every year | 2021 |
These ages are written for people without symptoms. A strong family history or an earlier result can change the timing, and your clinician decides with you which ones apply.
When does cervical screening start?
Cervical screening starts at 21, well before the others, and runs to 65 under the Task Force’s current recommendation from 2018.
From 21 to 29, that means a Pap test every 3 years. From 30 to 65 you get a choice of a Pap test every 3 years, an HPV test every 5 years, or both together every 5 years.
The Task Force recommends against screening after 65 for women who have had adequate screening before, and for most women after a hysterectomy that removed the cervix.
Is Medicare’s wellness visit a physical?
Medicare’s yearly wellness visit is a planning visit, and Medicare’s own coverage page says it “isn’t a routine physical exam.” You pay nothing for it if your provider accepts assignment, with no Part B deductible.
The visit opens with a health risk questionnaire. Your provider measures your height, weight and blood pressure, reviews your history and prescriptions, checks memory and thinking, talks through advance directives, then hands you a written plan of the screenings and vaccines you’re due for.
You take that written plan home with you. Keep it somewhere you’ll find it before next year’s visit.
New enrollees get a one-time “Welcome to Medicare” preventive visit within the first 12 months of Part B, and the first yearly wellness visit can’t fall within 12 months of either Part B enrollment or that Welcome visit. Say Part B starts in January and you have the Welcome visit in July, month 6. Your first wellness visit can come in month 18 at the earliest, and the next one in month 30.
How should you prepare for a physical?
Bring a list of every medicine you take, a short family health history and your questions written down. Medicare’s page on the Welcome visit asks for almost the same things, adding medical and vaccine records and the dose and timing of each drug, vitamin and supplement.
For family history, parents and siblings matter most. Write down what each one had and roughly how old they were when it started, since a close relative’s history can change when a screening starts.
Keep the question list to three or four, with the one you care about most at the top. On a long list, the last question is the one most likely to get rushed.
Before you walk in
Every screening in the table above comes from a recommendation dated between 2018 and 2024. Each one leaves the final call to a conversation between you and your clinician. A written list makes that conversation easier to have.
Tonight, write down the one question you most want answered and put it at the top of the page.
If something feels new, severe or won’t go away, book a visit for that now instead of saving it for your checkup.