Why primary care matters
Prevention is a long game, and it works best with someone who knows your history and sees your numbers change over years. Across 22 studies from nine countries, 18 found that greater continuity of care with the same doctor was linked to significantly lower mortality. In Norway's national registry, patients who had kept the same general practitioner for more than 15 years had about 25% lower odds of dying over the study year than those with a one-year relationship, along with fewer emergency admissions. At the population level, every 10 additional primary care physicians per 100,000 people in US counties was associated with 51.5 more days of life expectancy Moderate.
These are observational studies, and people who stay with one doctor differ in other ways. But the mechanism is plausible: a clinician who knows you notices a slow rise in blood pressure, remembers your father's heart attack, and follows up on abnormal results. Fragmented care is where things fall through the cracks.
The optimal care model
The free yearly preventive visit is the floor, not the plan. The optimal model:
| Part | Optimal | Guideline minimum |
|---|---|---|
| Clinician | A physician who practices prevention: orders ApoB and Lp(a), treats to optimal targets, and follows up | Any primary care clinician |
| Visit | A yearly comprehensive visit to review your numbers, family history, and plan | The ACA preventive visit; Medicare's yearly wellness visit |
| Labs | Core blood work every year; every three to six months while adjusting a medication or major habit | Lipids at least every 5 years; glucose at least every 3 years from 35 |
| Between visits | Home blood pressure readings, portal messages, and a plan for every abnormal result | Varies by practice |
A prevention-minded physician is recognizable. They order ApoB and Lp(a) when asked, look beyond 10-year risk (the PREVENT equations behind current US guidelines also estimate 30-year risk), treat clearly high blood pressure or ApoB without waiting for a calculator to cross a threshold, use a coronary calcium scan when the result would change a decision, and say no to tests that do more harm than good, such as whole-body CT. Many internists and family physicians practice this way within ordinary insurance; at a first visit, ask how they approach ApoB, Lp(a), and blood pressure goals. The tests and targets are in Blood tests and biomarkers and Heart and blood vessels.
When paying for more is worth it
Direct primary care, concierge medicine, or a longevity program is worth the money when it buys something your current care cannot Weak:
- Your clinician will not practice prevention. They decline ApoB or Lp(a), will not treat to targets, or cannot see you within a few weeks.
- Your risk is high or complicated. A strong family history, high Lp(a), diabetes, or several conditions benefit from closer follow-up.
- You can afford it without cutting the basics. Food, training, sleep, and the cheap tests come first.
It is not worth it when the fee mostly buys IV drips, hormones, supplements, or scans without a plan (see the red flags below). No study shows these programs extend life.
Free preventive care under the ACA
The Affordable Care Act requires most private health plans, including Marketplace plans, to cover a set of preventive services at no cost to you when you use an in-network provider, even before you meet your deductible. There are three main sources of the list:
| Source | What it covers | Examples |
|---|---|---|
| USPSTF A and B recommendations | Screenings, counseling, and preventive medicines graded A or B by the US Preventive Services Task Force | Blood pressure, colorectal, breast, cervical, and lung cancer screening; statins for higher-risk adults; diabetes screening |
| Vaccines recommended for adults | Vaccines on the CDC adult schedule | Flu, shingles, pneumococcal, Tdap, RSV for eligible adults; see Infections and vaccines |
| Women's preventive services | Guidelines from the Health Resources and Services Administration | Yearly well-woman visits, contraception, bone density screening after menopause, breast cancer risk counseling |
Medicare covers a yearly "Wellness" visit once every 12 months, plus many screenings. The Medicare wellness visit is a conversation to build a prevention plan, not a physical exam.
The 2025–2026 legal changes
In Kennedy v. Braidwood Management, decided June 27, 2025, the Supreme Court ruled 6–3 that the ACA's requirement to cover USPSTF-recommended services without cost-sharing is constitutional. It also held that the Secretary of Health and Human Services can remove Task Force members at will and review their recommendations. In May 2026, Secretary Kennedy dismissed the Task Force's chair and vice-chair. As of October 2026, the A and B recommendations and the coverage requirement are unchanged, but future changes could alter what plans must cover. Vaccine coverage depends on the CDC's recommendations, which have also changed since 2025; see Infections and vaccines.
What an annual checkup does and does not do
Trials of routine general health checks have been sobering. A Cochrane review of 17 trials found that general health checks in adults had little or no effect on total, cancer, or cardiovascular mortality Negative. That does not mean visits are useless. The trials tested screening checks in adults unselected for risk, not ongoing care that treats risk factors to targets. The value lies in the specific services delivered and acted on (blood pressure and ApoB control, cancer screening, vaccines) and in the relationship, not in a ritual head-to-toe exam or a long panel of untargeted tests. Use the visit to make sure the prevention checklist items due at your age actually happen.
Getting the most from your visit
What to bring
- Your medication list Every prescription, over-the-counter drug, and supplement, with doses. Bring the bottles if the list is out of date. See Supplements.
- Your numbers A week of home blood pressure averages, recent lab results from outside the practice, and any wearable alert you want explained. See Wearables and home monitoring.
- Your family history Which close relatives had heart disease, cancer, diabetes, or dementia, and at what age.
- Three questions, in priority order The most important first. Visits are short, and the last question of a visit rarely gets a good answer.
A short script helps:
- "Which screenings and vaccines am I due for, and where would a prevention-focused plan go further for me?"
- "Here is my family history. Does it change any of my screening ages or tests?"
- "Here are my home blood pressure averages and my medication list. Is anything worth changing?"
- "How do my ApoB, blood pressure, and HbA1c compare with optimal targets, and what is my 30-year cardiovascular risk?"
- "If a result comes back abnormal, how will I hear about it, and what is the plan?"
How to ask for a test
If you want a test your clinician did not offer, ask respectfully and give your reason. Clinicians respond best to a specific question tied to a guideline or a personal risk. For example: "The 2026 ACC/AHA cholesterol guideline recommends measuring lipoprotein(a) once in all adults. Could we add it to my next lipid panel?" or "My father had a heart attack at 52, and my LDL is borderline. Would a coronary calcium scan help us decide about a statin?" The heart, labs, and imaging chapters list which requests are guideline-based and which go beyond the guidelines; see Heart and blood vessels, Blood tests and biomarkers, and Scans and imaging.
Be prepared for a reasonable "no." Tests outside guidelines can cause false alarms, follow-up procedures, and bills. If you still want one, ask what it would cost out of pocket and what you would do with each possible result. If neither of you can answer the second question, the test is probably not worth it. If your clinician declines inexpensive tests this guide treats as optimal, such as ApoB with each lipid panel or a yearly HbA1c, you can order them through a lab membership or direct-to-consumer lab and bring the results back.
Second opinions
Second opinions are worth seeking for any serious diagnosis, recommended surgery, or treatment with major side effects. At Mayo Clinic, among patients referred for an outside diagnosis, the final diagnosis was distinctly different in 21% of cases and refined in another 66%. Many insurers cover them, and many major centers offer them remotely. Asking is routine; a good clinician will not be offended.
Family history and your records
Family health history
Your family history is one of the cheapest and most powerful risk tools in medicine. It can move the start of colon or breast cancer screening earlier, flag inherited cholesterol disorders, and point to genetic testing; see Cancer and Heart and blood vessels. A complete record covers three generations where possible: parents, siblings, and children first, then grandparents, aunts, uncles, nieces, nephews, and cousins.
For each relative, record the major conditions (heart attack, stroke, high cholesterol, cancer by type, diabetes, dementia, mental illness, and anything unusual), the age at diagnosis, and the age and cause of death. Note ancestry, which affects some genetic risks. Review it at each yearly visit and whenever a relative gets a new diagnosis. A shared document or spreadsheet works well; the CDC's My Family Health Portrait tool is no longer available as of 2026.
Keeping your own records
Under HIPAA you have the right to get copies of your health records, and providers generally must respond within 30 days. Under the 21st Century Cures Act, rules against information blocking require most providers to make your electronic records available without unreasonable barriers, which is why results often reach your portal before your doctor calls.
- Use the portal, and download lab results, visit notes, and imaging reports after each visit.
- Request imaging files, not just reports, for important scans such as coronary calcium, MRI, or mammograms. A future radiologist comparing old and new images can avoid unnecessary biopsies.
- Keep one master file with your medication list, allergies, vaccines, surgeries, family history, and key results. Your phone's health app or a simple folder is fine.
Beyond standard primary care
Direct primary care and concierge medicine
Direct primary care (DPC) practices charge a flat monthly fee for primary care, usually without billing insurance for visits, in exchange for smaller patient panels, longer visits, and direct messaging with your clinician. In a 2024 survey of 465 practices by the Direct Primary Care Alliance, the average fee was $98.46 a month. DPC is not insurance; you still need coverage for hospital care, specialists, and emergencies. Starting in 2026, people with HSAs can pay DPC fees of up to $150 a month ($300 for families) from their HSA.
Concierge practices charge an annual retainer on top of billing your insurance. Fees vary widely; one health system's program, for example, charges $4,560 a year for an individual in 2026. What you buy is time and access: same-day appointments, longer visits, and a phone number that reaches your doctor.
Longevity clinics
Longevity clinics sell intensive testing, coaching, and treatment programs aimed at extending healthspan. Prices range from a few hundred dollars a year for lab memberships such as Function Health ($365) and Superpower ($199) to $15,000 to $21,500 a year for premium clinic programs such as Biograph and Fountain Life, and far more at the top end (2026). The best ones offer what busy primary care often cannot: time to review your history, aggressive management of blood pressure and ApoB, exercise testing and training plans, and a coordinator who chases results. None has shown that its package extends life beyond what attentive, prevention-minded primary care plus exercise provides.
Telehealth
Telehealth works well for many preventive tasks: reviewing labs, refilling stable prescriptions, starting a statin, managing blood pressure with home readings, and treating straightforward conditions. Since 2025, HSA-compatible plans may permanently cover telehealth before the deductible. Amazon One Medical combines in-person primary care offices with 24/7 virtual visits under a membership. Online longevity services prescribe off-label drugs such as rapamycin after an intake form and labs; services and prices are in Longevity drugs.
Telehealth's weakness is fragmentation. A clinician who never examines you and does not see your full record can miss interactions and abnormal results. Whatever you start online, send the prescriptions and lab results to your primary care clinician.
Insurance, HSAs, and FSAs
Health savings accounts (HSAs) and flexible spending accounts (FSAs) let you pay for medical care with pre-tax money. For 2026, the HSA contribution limit is $4,400 for self-only coverage and $8,750 for family coverage. Starting January 1, 2026, Marketplace bronze and catastrophic plans count as HSA-compatible, which opens HSAs to many more people.
What qualifies is defined in IRS Publication 502: broadly, costs for diagnosing, treating, or preventing disease. Many lab memberships, CGMs, and wearables are marketed as HSA and FSA eligible, but eligibility depends on the item and sometimes on a letter of medical necessity. Check with your plan administrator before a large purchase, and keep receipts.
The rest of your team
- Dentist and hygienist Cleanings and exams every six months, or every three to four months with gum disease, which is linked to heart disease and dementia. See Eyes, ears, teeth, and skin.
- Eye doctor An eye exam every two years from 18, a dilated baseline exam by 40, and yearly exams from 65 or with risk factors. The American Academy of Ophthalmology's minimum is a baseline at 40. See Eyes, ears, teeth, and skin.
- Dermatologist A full-skin exam every two years from 40 if you have light skin, and yearly, starting younger, with many moles, past sunburns, or a family history of melanoma. Check your own skin monthly in between. See Eyes, ears, teeth, and skin.
- Pharmacist The most accessible expert on interactions. Ask for a full medication and supplement review once a year, ideally at one pharmacy.
- Therapist For depression, anxiety, insomnia, grief, and stress; you do not need to be in crisis. See Mind and connection.
- Physical therapist For pain, injuries, balance, and returning to training. As of July 2025, all 50 states allow you to see a physical therapist directly, though some limit how long without a referral.
- Registered dietitian For diabetes, kidney disease, weight, or a complicated diet. Medicare covers medical nutrition therapy for diabetes and kidney disease with a referral.
- Trainer or coach For learning to lift safely and sticking with a program. Look for a recognized certification and experience with your age and conditions. See Exercise.
What different budgets buy
Spend in order of value. The free floor plus the second tier deliver most of the optimal plan; each higher tier mostly buys convenience, time, and more data. Prices are approximate and as of October 2026.
| Annual budget | What you get | What it adds |
|---|---|---|
| $0 (the floor) | ACA preventive visit, guideline screenings, recommended vaccines, a pharmacy blood pressure cuff | The guideline minimum, which already covers much of the proven benefit |
| About $500 | Your own validated cuff (basic models list near $47), a scale and tape measure, and self-pay labs with ApoB once or twice a year (for example, Function Health at $365 tests twice a year) | Most of the optimal plan: home blood pressure and yearly numbers to treat to target |
| About $1,500 to $3,000 | The above plus direct primary care (about $1,200 a year at the average fee), a yearly DEXA scan and VO2 max test, a wearable, a CGM stint, or a coronary calcium scan when it would change a decision | A clinician who knows you and answers messages; better data for training and treatment |
| $5,000 to $20,000 or more | Concierge medicine or a premium longevity program, with coordinated testing, imaging, and coaching | Time, coordination, and close management; no proven extra years beyond the tiers above |
Planning for serious illness
Advance care planning means deciding, while you are well, who will speak for you and what care you would want if you could not speak for yourself. Only about 36.7% of US adults have completed any advance directive.
Two documents do most of the work. A durable power of attorney for health care names your healthcare proxy, the person who makes medical decisions if you cannot. A living will records your wishes about treatments such as resuscitation, breathing machines, and feeding tubes. Forms vary by state and are usually free. Choose a proxy who knows your values and can act calmly under pressure, tell them and your family what you want, give copies to your clinician, and review the documents after major life events. With a serious illness, ask for palliative care early; it is not the same as hospice and can run alongside curative treatment. See Aging well after 65.