FAA Medical Certificate Complete Guide

The FAA issues three classes of medical certificates under 14 CFR Part 67. Each class corresponds to the privileges you intend to exercise:

First-class medical: Required for Airline Transport Pilot (ATP) operations — airline captains and first officers. This is the most stringent exam. Valid for 12 months if under 40, 6 months if 40 or older (for first-class privileges). After expiration of first-class privileges, it reverts to lower-class validity.

Second-class medical: Required for Commercial Pilot operations — flying for compensation or hire. Valid for 12 months regardless of age (for second-class privileges). The exam standards are slightly less restrictive than first class.

Third-class medical: Required for Private Pilot and Recreational Pilot operations. Valid for 60 months if under 40, 24 months if 40 or older. This is the baseline medical most student pilots obtain.

All three classes are issued through the same AME visit. The difference is the standard applied during the exam and the validity period. Many pilots obtain a higher class than needed so they have a longer runway before renewal.

BasicMed (14 CFR Part 68) allows pilots to fly without a traditional FAA medical certificate, provided they meet specific criteria. It was introduced in 2017 to reduce barriers for general aviation pilots.

Eligibility: You must have held an FAA medical certificate issued under part 67 at any point after July 14, 2006 — and it need not still be valid: 14 CFR 61.23(c)(3)(ii)(B) says the most recently issued one may be expired. Three separate bars apply, and the rule keeps them apart: your most recent certificate cannot have been suspended or revoked ((ii)(C)); your most recent Authorization for a Special Issuance cannot have been withdrawn ((iii)); and your most recent application cannot have been completed and denied ((iv)). Note that (ii)(A) expressly allows the most recent certificate to includea special issuance — having had one is not a bar; having it withdrawn is. If you never held a medical certificate you must obtain one first; the rule says "a medical certificate issued under part 67" and does not name a class, so third class is the usual choice rather than a requirement.

Requirements: Complete a comprehensive medical examination with any state-licensed physician (not necessarily an AME) within the preceding 48 calendar months, and the online medical education course within the preceding 24 calendar months — 14 CFR 61.23(c)(3)(i)(D) and (C) respectively. Both rules say calendar months, which run to the end of the month, and the two clocks are different lengths: they will not stay in step.

Limitations: You may fly aircraft with a maximum of 7 occupants (no more than 6 passengers), a maximum takeoff weight of 12,500 pounds, at altitudes up to 18,000 feet MSL, at speeds up to 250 knots indicated airspeed, and the aircraft must not be a transport-category rotorcraft certificated under part 29. Flight outside the United States is not forbidden outright — 14 CFR 61.113(i)(2)(ii) bars it unless authorized by the country in which the flight is conducted, which is why the Bahamas arrangement exists. The passenger figure is 6, as stated above: the 5-passenger limit belongs to the pre-2024 rule, which amendment 61-158 (effective 18 November 2024) replaced when it raised the aircraft to 7 occupants and 12,500 pounds.

BasicMed is popular among recreational pilots who find the traditional medical process burdensome, especially those with conditions that complicate FAA medical issuance but pose no real safety risk.

The Aviation Medical Examiner (AME) is a physician designated by the FAA to conduct airman medical examinations. Find an AME near you using the FAA's AME Locator tool on the FAA website.

Before the visit:Create a MedXPress account on the FAA's website and complete FAA Form 8500-8 (Application for Airman Medical Certificate) online. You will receive a confirmation number to bring to your appointment. Be thorough and honest — the FAA cross-references your responses with other databases.

During the exam: The AME will check your vision (near and distant, corrected is acceptable), color vision (Ishihara plates or alternatives), hearing (conversational voice test or audiometry), blood pressure, heart rhythm (ECG required for first-class at age 35 and older), urinalysis, and general physical condition. The visit typically takes 30-45 minutes.

After the exam:Most third-class applicants receive their medical certificate on the spot. If the AME identifies an issue that requires further review, your application is deferred to the FAA's Aerospace Medical Certification Division (AMCD) in Oklahoma City for a decision.

Medical certificate validity depends on your age and the class of medical you hold. Here are the durations for exercising the specific class privileges:

First-class: 12 months (under 40), 6 months (40 and older). After first-class privileges expire, it functions as a second-class for the next 6-12 months, then as a third-class for the remaining duration.

Second-class: 12 months regardless of age. After second-class privileges expire, it functions as a third-class for the remaining duration.

Third-class: 60 months (under 40), 24 months (40 and older).

All durations are calculated using calendar months from the date of the exam. A medical issued on April 16, 2026, with a 24-month validity expires at the end of April 2028.

Renewal is straightforward: schedule a new AME visit before your current medical expires. There is no grace period — if your medical expires, you cannot act as pilot-in-command until you have a new one.

Special Issuance (SI) is the process by which the FAA grants a medical certificate to pilots with medical conditions that would normally be disqualifying. Conditions like diabetes (insulin-treated), heart disease (post-bypass or stent), sleep apnea, and certain cancers can all receive Special Issuance approval.

The SI process requires documentation from your treating physician, often including specialist reports, lab work, and treatment records. The AMCD reviews everything and may issue a time-limited medical with follow-up reporting requirements. Initial SI processing can take 3-6 months.

SODA (Statement of Demonstrated Ability) is a one-time evaluation for pilots with a stable physical limitation — such as loss of a limb, monocular vision, or deafness in one ear. A flight test is conducted to demonstrate that the limitation does not impair your ability to fly safely. Once issued, a SODA is permanent and does not need to be renewed.

Mental health has historically been a significant concern for pilots seeking medical certification. The FAA has modernized its approach considerably, though the process remains more involved than for physical conditions.

SSRI use: The FAA established a protocol in 2010 allowing pilots to use certain SSRIs (fluoxetine, sertraline, citalopram, escitalopram) for mild to moderate depression or anxiety. Approval requires a minimum 6-month stable period on the medication, a psychiatric evaluation (HIMS AME), and ongoing monitoring with annual CogScreen testing.

ADHD: A history of ADHD does not automatically disqualify you. If you have not taken medication since age 18 and can demonstrate stable performance, certification is possible. Recent ADHD medication use requires a more detailed evaluation.

Substance abuse history: A DUI/DWI or substance-related offense must be reported. The FAA requires a substance abuse evaluation through a HIMS (Human Intervention Motivation Study) AME. Certification is possible with documented recovery and ongoing monitoring.

The most important rule: always be truthful on your MedXPress application. Concealing a condition is a federal offense and will result in certificate revocation if discovered.