What are the recommended annual wellness visit screenings and interventions for a healthy adult with no underlying medical conditions?

Annual Wellness Visit for Healthy Adults

For a healthy adult with no underlying medical conditions, annual wellness visits should focus on age-appropriate cardiovascular risk screening (blood pressure and lipids), cancer screening based on age and sex, lifestyle counseling, and selective laboratory testing—not comprehensive physical examinations or routine laboratory panels, which lack evidence of benefit. 1, 2

Core Components for All Adults

Cardiovascular Screening

• Blood pressure measurement at every visit is the single most important screening test across all age groups 1, 2, 3
• Lipid profile screening (total cholesterol, LDL, HDL, triglycerides) should begin annually or every 6-12 months, particularly as patients approach age 40 1, 2, 3
• Non-fasting samples are acceptable for lipid screening in average-risk individuals 3

Metabolic Screening

• Hemoglobin A1C or fasting glucose is indicated only if BMI ≥25 kg/m² with additional risk factors (first-degree relative with diabetes, high-risk ethnicity, cardiovascular disease, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL, or physical inactivity) 1, 3
• If prediabetes is identified, yearly testing is recommended; otherwise, repeat every 3 years if normal 3

Age-Specific Recommendations

Adults 18-39 Years

• Blood pressure at every visit 1
• Lipid screening annually or every 6-12 months as approaching age 40 1, 3
• Hemoglobin A1C if BMI ≥25 kg/m² with risk factors 1, 3
• Cancer-related checkup every 3 years including examination for thyroid, testicular, lymph node, oral cavity, and skin cancers 3
• Health counseling about tobacco, sun exposure, diet, physical activity, sexual practices, and environmental exposures 3

Adults 40-49 Years

• Annual blood pressure and lipid profile 1, 2
• Colorectal cancer screening starting at age 45 with annual fecal immunochemical test (FIT), colonoscopy every 10 years, or CT colonography every 5 years 1, 2
• Mammography annually for women starting at age 40 1
• Hemoglobin A1C or fasting glucose if BMI ≥25 kg/m² with risk factors 1

Adults 50-64 Years

• Annual blood pressure, lipid profile, and fasting glucose or hemoglobin A1C 1
• Colorectal cancer screening with annual FIT, colonoscopy every 10 years, or flexible sigmoidoscopy every 5 years 1
• Prostate cancer screening discussion at age 50 using shared decision-making about PSA testing (African American men or those with strong family history should begin discussion at age 45) 1, 2
• Mammography annually for women 1

Adults 65-74 Years

• Annual blood pressure, lipid panel, and fasting glucose or HbA1c 1
• Comprehensive metabolic panel and urinalysis if clinically indicated 1
• Lung cancer screening with low-dose CT for those aged 55-74 with at least 30 pack-year smoking history who currently smoke or quit within past 15 years 1
• Annual cognitive screening using validated tools such as Montreal Cognitive Assessment (MoCA) 4, 1
• Depression screening 1

Adults 75+ Years

• Annual blood pressure, lipid panel, and fasting glucose or HbA1c, individualized based on life expectancy and treatment goals 1
• Selective laboratory testing (CBC, urinalysis) only if clinically indicated 1
• Lung cancer screening with low-dose CT for those aged 55-80 with at least 30 pack-year smoking history who currently smoke or quit within past 15 years 1
• Annual cognitive and depression screening 4, 1

Essential Lifestyle Counseling

• Tobacco cessation counseling if applicable 3
• Diet and nutrition guidance focusing on maintaining BMI <25 kg/m² 4, 3
• Physical activity recommendations 4, 3
• Alcohol and substance use counseling 3
• Depression and anxiety screening 3

What NOT to Do: Critical Pitfalls

Avoid Routine Comprehensive Physical Examinations

• The traditional annual comprehensive physical examination lacks evidence of value and has been successfully challenged by multiple evidence-based reviews 4, 5
• Despite physician belief that comprehensive examinations detect subclinical illness, studies do not support this practice 5, 6

Avoid Routine Laboratory Panels Without Indication

• Do not order routine CBC or comprehensive metabolic panels in asymptomatic adults without specific clinical indications 1, 2
• Many physicians inappropriately order unproven screening tests including urinalysis (44%), blood glucose (46%), and CBC (39%) as part of routine examinations 6
• These tests lead to false positives, unnecessary follow-up, and patient anxiety without improving outcomes 2

Avoid Inappropriate PSA Testing

• Do not order PSA testing before age 50 for average-risk men, as harms of screening and overtreatment outweigh potential benefits 2
• Exception: African American men or those with strong family history should have screening discussion at age 45 2

The Evidence Behind This Approach

The shift away from comprehensive annual physical examinations is supported by joint recommendations from the American Cancer Society, American Diabetes Association, and American Heart Association, which acknowledge that "several evidence-based reviews determined [the annual physical examination] had little empirical evidence of value" 4. However, these organizations emphasize the critical importance of targeted screening for specific risk factors including hypertension, dyslipidemia, diabetes, and cancer 4.

The Medicare Annual Wellness Visit provides a structured framework for preventive care that focuses on health risk assessment, cognitive evaluation, and individualized prevention planning rather than comprehensive physical examination 4, 7. Studies demonstrate that wellness visits lead to identification of previously unrecognized diagnoses and improve delivery of recommended clinical preventive services 8.

The key is to focus on evidence-based, age-appropriate screening rather than comprehensive examinations or routine laboratory testing. 1, 2, 8