Biomarker testing in Germany covers five values and you pay for the rest

Biomarker testing in Germany begins for most people at the Check-up 35, and that examination measures exactly five values in your blood. Those five are total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides and a fasting glucose reading, alongside a urine dipstick test and a physical examination.¹

Under the Gesundheitsuntersuchungs-Richtlinie you may have that examination once between the ages of 18 and 34, and then every three years from your 35th birthday.¹ From 35 you also have a one-off screening for hepatitis B and hepatitis C.¹ Under 35 the blood is only taken when a risk profile already justifies it.¹

What surprises people is what the name does not include. A großes Blutbild, which counts your blood cells, is not part of the Check-up 35 at all, and neither is your iron status, your thyroid, your inflammation or your three-month blood sugar average.

Even the covered part goes mostly unused. Techniker Krankenkasse examined the records of 5.8 million eligible members and found that 1.45 million of them attended, which is 24.8 percent for that year.²

Why your doctor will not simply add more biomarkers

The obvious next move is to ask your GP for more values, and the usual answer is no. That answer is about money rather than medicine, and the numbers behind it are published.

German practices are paid a Wirtschaftlichkeitsbonus, an economy bonus for laboratory ordering, only while the practice keeps its average laboratory cost per patient case under a set figure. For general practice the lower threshold is 1.42 euro per case and the upper threshold is 3.37 euro, and above the upper figure the bonus is nothing at all.³

A single vitamin D measurement costs between 27.98 and 32.18 euro in laboratory fees.⁸ A handful of broad panels ordered for people without symptoms is therefore enough for a practice to lose that bonus across every patient it treats in the quarter.

Documented diagnoses carry Kennnummern, which are codes that exempt a test from the budget entirely. That is why the same doctor can order the same test freely for a patient with a written suspicion and decline it for a patient who simply feels tired. None of this is bad medicine, because the German system was built to find disease in people with symptoms rather than to measure health in people without any. It just means that the moment you want more than five values, you have become a Selbstzahler, somebody paying for their own care.

Which biomarkers a German check-up leaves out entirely

Everything in the list below is absent from the statutory examination, and every one of them is a marker people ask for by name. Each links to the reference page with its ranges, its sample requirements and what it is best read with.

• Ferritin shows how much iron you have in storage, and it falls long before a blood count looks abnormal, with transferrin saturation as its companion measure.
• Vitamin D was measured as 25-hydroxyvitamin D in 6,995 German adults during the DEGS1 survey, where 61.6 percent were below 50 nmol per litre and 30.2 percent were below 30.⁴
• HbA1c gives your average blood sugar across roughly three months, while the check-up glucose value only describes the morning you happened to attend.
• TSH is the first test for an underactive or overactive thyroid, and tiredness on its own rarely gets it ordered for you.
• High-sensitivity CRP measures low-level inflammation, which the ordinary CRP test used for infections cannot detect at that resolution.
• Lp(a) is largely inherited and stays roughly constant for life, and the 2025 ESC and EAS update recommends considering one measurement in each adult's lifetime, with 50 mg per decilitre as the level of clinical significance.⁵
• Apolipoprotein B counts the actual number of artery-damaging particles rather than the cholesterol carried inside them.
• The omega-3 index reports the EPA and DHA content of your red blood cell membranes, and no statutory German examination includes it.
• Vitamin B12 matters most for people eating little or no animal food, and prolonged shortfall can cause nerve damage that does not fully reverse.

Absence from the check-up does not make a marker useful for everybody. The IGeL-Monitor rates screening healthy adults for vitamin D deficiency as unclear, because no study has yet measured the benefit or harm of the screening itself.⁸ A marker earns its place when you intend to act on the answer, and the full Aniva biomarker library exists so you can read what each one is for before you choose.

Why one biomarker test on its own changes almost nothing

So you pay for the panel, and about a week later a Befund arrives, which is the written laboratory report with your values printed against their ranges. This is the point at which most people stop, and it is the most important part of the whole sequence to understand.

A Referenzbereich is not a target and it is not a definition of health. Most ranges are calculated as the central 95 percent of measurements from a reference population, so roughly one healthy person in twenty falls outside any given range by arithmetic alone.⁶ On a report carrying eighteen values, such as a großes Blutbild combining the kleines Blutbild with the Differentialblutbild, one flagged number is the expected outcome rather than a warning.

Two consequences follow from the way those ranges are built. The first is that a value comfortably inside the range can still be considerably worse than the same value two years ago, and one report cannot tell you that because it has nothing to compare against. The second is that a single flagged number means very little on its own, which is why a clinician reads several markers together and asks what has changed.

Timing changes results too, so a Nüchternblutabnahme after 8 to 12 hours without food is required for glucose and triglycerides, while a blood count needs no fasting at all. A morning sample matters for testosterone, and hormone values during the Wechseljahre or with PCOS move so much across a cycle that one draw describes a day rather than a year.

The useful unit in biomarker testing is therefore not a test. It is the same markers measured again under the same conditions, with somebody who explains what moved and what to do about it.

The four ways to arrange biomarker testing in Germany

Once you accept that you are paying, four routes are open to you, but none of them requires a doctor to agree that you are ill first. They differ in what they cost, in how much interpretation you get and in whether anybody expects to see you again.

• Ask your own GP for an IGeL-Leistung, an individuelle Gesundheitsleistung priced under the GOÄ private fee schedule, where the practice must tell you the cost in writing beforehand.
• Go directly to a private laboratory running a Selbstzahler service, which is usually the cheapest per analysis and comes with no interpretation whatsoever.
• Ask a pharmacy that has begun offering blood draws, which became legal across Germany on 2 July 2026.
• Take a membership that includes the panel, the draw, the report and the retest for one yearly price.

The pharmacy route is the newest and the least evenly available. Section 11c of the Apothekengesetz now allows a licensed Apotheker, meaning a fully qualified pharmacist, to take a venous blood sample in their own public pharmacy.⁷ The pharmacist needs a confirmed medical training first, the purpose has to be diagnostic, and the person giving the sample has to be 18 or over.⁷ A PTA may not take the sample, and the Bundesapothekerkammer model curricula for that training are due on 2 November 2026, so few pharmacies offer it during 2026.

If you would rather compare the first three routes in detail, we have written separately on booking a blood test online in Germany, on getting a blood test without a doctor and on what a standard Blutbild covers and misses.

How Aniva puts the whole chain into one membership

The fourth route is the one that answers the problem this article has described, because the difficulty was never finding a laboratory. The difficulty is that a panel, a draw, an explanation and a repeat in twelve months are four separate purchases everywhere else, and the explanation is the one that nobody sells.

199 € per year · 0.55 € per day. Cheaper than a similar test at your doctor. Guaranteed. If not, we will match the price.

A comparable private panel arranged through a doctor costs 300 euro or more, and that figure usually buys the analysis alone. Your Core panel is included in your membership, and so is everything in the list below.

• You book at one of over 25 locations in Germany, where a trained person takes the same blood draw a doctor would take.
• Your panels are clinician-designed and medically reviewed, so the marker list was chosen deliberately rather than assembled from whatever is inexpensive.
• Results for standard markers are usually available within 10 days, while special analyses such as genetics or the omega-3 index take about two weeks.
• Every value is read against both a normal range and an optimal range, together with your age, your sex and the rest of your panel, which is the comparison a single Befund cannot make.
• Your report explains each value in plain language with context and next steps, and every marker has its own reference page you can read at any hour.
• Your personal action plan gives you 3 to 5 concrete steps, your prioritized issues, a supplement plan where the markers warrant one and a retest schedule.
• A personal health concierge answers your questions about what an individual value means for you.
• Retesting the same markers next year is the point of a membership, because your own previous result is the only comparison that describes you.

There is no hard sell on supplements at any stage, because members find the right ones through their plan and their concierge, and when the markers do not warrant a supplement the plan does not recommend one. If you have private insurance, our page on insurance and reimbursement sets out what can be claimed.

Get started whenever it suits you, see what is tested before you decide anything, or read the glossary if the German terms on your last Befund were the problem.

A summary of the main points

• Your statutory Check-up 35 measures four lipid values and one glucose value, plus a urine test and a one-off hepatitis screening from age 35.
• You may have it once between 18 and 34 and then every three years from 35, and about a quarter of eligible people attend.
• Your GP works to a laboratory budget of 1.42 to 3.37 euro per patient case, which is why a broad panel is rarely added for somebody who feels well.
• Ferritin, vitamin D, HbA1c, TSH, high-sensitivity CRP, Lp(a), ApoB and the omega-3 index all have to be arranged privately without a documented indication.
• A reference range covers the central 95 percent of a reference population, so one flagged value on an eighteen-value report is expected rather than alarming.
• A single test cannot tell you whether a value has moved, which makes repeated measurement of the same markers the thing actually worth buying.
• You can pay your GP privately, use a laboratory directly, ask a pharmacy since July 2026, or take a membership that includes the draw, the report and next year's retest.

Questions we are asked most often

Does my Krankenkasse pay for a biomarker test?

Your statutory insurance pays for the Check-up 35, which covers total cholesterol, LDL, HDL, triglycerides and fasting glucose, plus a urine test and a one-off hepatitis screening from age 35.¹ Any other marker needs a documented medical indication before it is covered. Without that indication you pay for it yourself as an IGeL-Leistung.

Why will my doctor not order more blood values for me?

General practices receive a laboratory economy bonus only while their average laboratory cost stays under 3.37 euro per patient case, and the bonus reaches zero above that figure.³ Ordering broad panels for people without symptoms therefore risks that bonus across the whole practice. Documented diagnoses carry codes that exempt a test from the budget, which is why an indication changes the answer completely.

How often should I have my biomarkers measured?

Once a year suits most healthy people who want to follow a trend, because a single measurement has no comparison and a Referenzbereich describes a population rather than you.⁶ Anyone changing a medication, a diet or a training load has reason to retest sooner. Your own previous values are the comparison that means something.

Can a pharmacy in Germany take my blood now?

Since 2 July 2026 a licensed pharmacist may take a venous sample in their own public pharmacy, after a confirmed medical training, for diagnostic purposes and only for adults aged 18 or over.⁷ A PTA is not permitted to take the sample at all. The model curricula for that training are due on 2 November 2026, so relatively few pharmacies offer this today.

What does a private blood panel cost in Germany?

A comparable private panel arranged through a doctor costs 300 euro or more, and a single vitamin D analysis alone costs between 27.98 and 32.18 euro in laboratory fees.⁸ An Aniva membership costs 199 euro for the year and includes your Core panel, your report and your action plan. If you find a similar test for less, we will match that price.

My values are all inside the reference range, so am I healthy?

A reference range is the central 95 percent of measurements from a reference population, which means one healthy person in twenty falls outside a given range with nothing wrong.⁶ A value can also be well inside the range but still be much worse than your own result last year. Reading several markers together, and against your own history, tells you far more than any single flag.

Do I need to fast before a biomarker test?

A Nüchternblutabnahme of 8 to 12 hours without food is needed for glucose and triglycerides, because both rise after eating. A großes Blutbild is barely affected by food and needs no fasting. Water is fine throughout, and you should ask before stopping any regular medication.

Notes and sources

1. Gemeinsamer Bundesausschuss, Gesundheitsuntersuchungen ("Check-up"), and the Kassenärztliche Bundesvereinigung summary of the Gesundheitsuntersuchungs-Richtlinie. Covers the lipid profile, fasting glucose, urine status, the age and interval rules and the one-off hepatitis B and C screening. g-ba.de and kbv.de
2. Deutsches Ärzteblatt, "Jeder vierte Berechtigte nutzt Check-up 35", reporting a Techniker Krankenkasse analysis of 5.8 million eligible members of whom 1.45 million attended, which is 24.8 percent. Single insurer data rather than a national figure. aerzteblatt.de
3. Kassenärztliche Bundesvereinigung, Wirtschaftlichkeitsbonus Labor, giving the general practice thresholds of 1.42 and 3.37 euro of average laboratory cost per case, and the reduction of the bonus to zero above the upper threshold. kbv.de
4. Rabenberg M, Scheidt-Nave C, Busch MA, Rieckmann N, Hintzpeter B, Mensink GBM. Vitamin D status among adults in Germany, results from the German Health Interview and Examination Survey for Adults (DEGS1). BMC Public Health 2015;15:641. 6,995 adults aged 18 to 79, surveyed from November 2008 to December 2011, with 61.6 percent below 50 nmol per litre and 30.2 percent below 30 nmol per litre. doi:10.1186/s12889-015-2016-7
5. European Society of Cardiology and European Atherosclerosis Society, 2025 focused update of the 2019 guidelines for the management of dyslipidaemias, recommending that Lp(a) measurement at least once in each adult's lifetime be considered, class IIa level B, with clinical significance above 50 mg per decilitre. escardio.org
6. Hall N et al. The role and limitations of the reference interval within clinical chemistry and its reliability for disease detection. British Journal of Biomedical Science 2024;81:12339, on reference intervals defined as the central 95 percent of a healthy reference population. doi:10.3389/bjbs.2024.12339
7. Section 11c Apothekengesetz, in force since 2 July 2026 under the Apothekenversorgung-Weiterentwicklungsgesetz, BGBl. 2026 I Nr. 195. Venous blood draw by a licensed pharmacist after a confirmed medical training, in their own public pharmacy, for people aged 18 or over and for diagnostic purposes. gesetze-im-internet.de
8. IGeL-Monitor, Früherkennungsuntersuchung auf Vitamin-D-Mangel, assessment published 9 November 2022, rating the benefit of screening healthy adults as unclear and giving laboratory costs of 27.98 to 32.18 euro. igel-monitor.de

This article is general health information for people in Germany and it does not replace a medical diagnosis or the advice of a doctor. Reference intervals belong to the analysing laboratory, and the interpretation of any individual result remains a matter for your treating clinician.