As China stands on the brink of entering a severely aging society, addressing how to effectively improve and safeguard elderly health while advancing healthy aging has emerged as a pivotal public health issue. Effectively transforming the elderly’s health risk behaviors is crucial for China’s steady progress toward healthy aging, and the Plan for Free Health Check-up (PFHC) tailored for the elderly is expected to act as a key initiative in facilitating such behavioral changes.

This paper first constructs a theoretical model to explore the mechanism through which the PFHC affects the transformation of the elderly’s health risk behaviors. Subsequently, utilizing four waves of 2011–2018 microdata from the China Health and Retirement Longitudinal Study (CHARLS), a staggered DID model is adopted to empirically assess the program’s impact on health risk behaviors. The results indicate that the implementation of the PFHC exerts a significantly inhibitory effect on the probability of health risk behaviors, primarily through reducing biased health perceptions. Subsample heterogeneity analysis reveals that the intervention has a stronger suppressive effect on smoking and alcohol consumption among elderly men, while it is more effective in promoting regular physical activity and improving sleep quality among elderly women. Moreover, the policy effect of the PFHC is particularly pronounced among elderly individuals with lower education and rural residents. Further analysis reveals that improved healthcare conditions and digital empowerment enhance the PFHC’s effectiveness in reducing health risk behaviors. Additionally, the PFHC significantly improves elderly health status, largely due to changes in health risk behaviors.

The marginal contributions of this paper are as follows: First, by exploring the policy effect of the PFHC from the perspective of the elderly’s health risk behaviors, it broadens the understanding of the program’s implementation outcomes. Second, leveraging the PFHC as a quasi-natural experiment, it accurately estimates the causal effect of health check-ups on health risk behaviors. This not only supplements the literature on health risk behavior determinants, but also affirms health check-ups’ pivotal role in improving elderly health and advancing healthy aging. Third, it incorporates biased health perceptions into the health behavior change theory, demonstrating that external policies can affect health risk behaviors by shaping biased health perceptions, ultimately contributing to the improvement of their health conditions.