Preventive health is a broad term encompassing screening tests (e.g., for cancer, cardiovascular risk, or geriatric syndromes), healthy lifestyle counseling (e.g., nutrition and physical activity), immunizations, and safety considerations (e.g., falls, driving). These discussions become more important with age as a clinician considers an individual patient's goals and values, prognosis and life expectancy, and whether a patient is likely to benefit. The 4Ms (what Matters, Medications, Mentation, and Mobility) provide a useful framework for thinking about how to frame discussions with older adults in the primary care setting, and the Medicare Annual Wellness Visit provides an opportunity to review screening and prevention with an older adult and to update goals and preferences. The overarching goal should be to follow evidence-based practice, cause no harm to our patients, and align with what matters most to the patient.