FAA Medical Certificate Requirements — First, Second, and Third Class

The FAA requires pilots to hold a valid medical certificate to exercise most pilot certificate privileges. Medical standards are established in 14 CFR Part 67 and administered by FAA Aviation Medical Examiners (AMEs). The class of medical certificate required depends on the type of operation — ATP operations require first class, commercial operations require at least second class, and private operations require at least third class. This guide covers all three classes, BasicMed, and the special issuance process.

Three Classes of FAA Medical Certificates

First Class Medical Certificate

A first class medical is required to exercise ATP certificate privileges. It is the most stringent class and includes electrocardiogram (EKG) requirements beginning at age 35. First class medical duration when exercising ATP privileges:

• Under age 40: valid for 12 calendar months for first-class privileges
• Age 40 and older: valid for 6 calendar months for first-class privileges
• Valid for 12 months for second-class privileges regardless of age
• Valid for 60 months (under 40) or 24 months (40+) for third-class privileges

Second Class Medical Certificate

A second class medical is required to exercise commercial pilot privileges. It has slightly less stringent standards than first class. Duration:

• Valid for 12 calendar months for second-class commercial privileges (all ages)
• Valid for 60 months (under 40) or 24 months (40+) for third-class privileges

Third Class Medical Certificate

A third class medical is required for private pilot, recreational pilot, and student pilot operations. It is the least stringent class:

• Under age 40: valid for 60 calendar months (5 years)
• Age 40 and older: valid for 24 calendar months (2 years)

Medical Certificate Duration — Quick Reference Table

BasicMed — Alternative to Third Class Medical

BasicMed, established by the FAA Extension, Safety, and Security Act of 2016, allows eligible private pilots to fly without holding an FAA medical certificate. Instead, they must meet requirements under 14 CFR §61.23(c) and Part 68.

BasicMed Requirements

• Hold a valid US driver's license
• Have held a valid FAA medical certificate at any time after July 14, 2006 (even if it has since expired)
• Complete a medical examination with any state-licensed physician using the FAA Comprehensive Medical Examination Checklist (CMEC, FAA Form 8700-2) every 48 calendar months
• Complete the online aeromedical factors course (available through AOPA or EAA) every 24 calendar months
• Not have had an FAA medical certificate denied, revoked, or suspended since July 15, 2016

BasicMed Operating Limitations

Pilots using BasicMed may only:

• Fly aircraft not requiring a type rating, with no more than 6 seats and maximum certificated takeoff weight of 6,000 lbs
• Carry no more than 5 passengers
• Fly at or below 18,000 ft MSL
• Fly at speeds no greater than 250 KIAS
• Fly within the United States only
• Not fly for compensation or hire

First Class Medical Standards

First class medical standards under 14 CFR Part 67, Subpart B include:

Vision (§67.103)

• Distant visual acuity: 20/20 or better in each eye separately, with or without correction
• Near visual acuity: 20/40 or better at 16 inches (with or without correction)
• Intermediate vision (age 50+): 20/40 or better at 32 inches
• No active pathology of the eye that would interfere with vision
• Color vision: must be able to perceive those colors necessary for safe performance of flight duties

Cardiovascular (§67.107)

• No established medical history or clinical diagnosis of myocardial infarction, angina pectoris, or coronary artery disease that has required treatment
• No cardiac valve replacement
• No permanent cardiac pacemaker without special issuance
• Resting EKG required at initial first class exam and annually at age 35 and older
• Blood pressure: generally not to exceed 155/95 (higher values may require evaluation)

Hearing (§67.105)

The applicant must demonstrate hearing of an average conversational voice in a quiet room, using both ears, at a distance of 6 feet with the back turned to the examiner — or demonstrate acceptable hearing with use of hearing aids.

Common Reasons for Medical Denial and Special Issuance

Many conditions that would initially disqualify a pilot can be addressed through the FAA Special Issuance process. An Aviation Medical Examiner or the FAA's Aerospace Medical Certification Division (AMCD) reviews these cases. Common conditions:

Diabetes

Type 2 diabetes controlled by diet and exercise alone: usually eligible for all classes. Type 2 diabetes controlled by oral medications: eligible for all classes via CACI (Conditions AMEs Can Issue). Insulin-treated diabetes: third class special issuance available as of 2015; first and second class special issuance established by 2019 FAA policy. Requires specific monitoring protocols and glucose reporting.

Cardiac History

History of myocardial infarction, coronary artery bypass, angioplasty, or stent placement typically requires a special issuance. The FAA evaluates these cases through cardiac testing protocols including stress testing, echocardiography, and sometimes catheterization reports. Many pilots with treated cardiac disease successfully obtain special issuances.

Mental Health Conditions

Certain mental health conditions and their treatments can affect eligibility. The FAA maintains a list of accepted psychiatric medications (SSRIs, anxiolytics) for which HIMS AME monitoring and special issuance are available. Untreated or actively symptomatic mental health conditions that may be a safety risk are disqualifying.

Substance Abuse — AASI Process

History of alcohol or substance abuse or dependence requires evaluation through the HIMS AME process and submission of an Airman Comprehensive Substance Investigation (AASI). Pilots with treated substance use disorders may be eligible for special issuance with ongoing monitoring, typically through HIMS AME oversight and random testing programs.

Common FAA Medical Questions Pilots Ask

Q: If I hold a first class medical, can I use it for private pilot operations after it expires for ATP use?

Yes. A first class medical issued to a pilot under age 40 that has passed its 12-month first-class validity may still be used for third-class privileges until 60 months from the date of examination. This is sometimes called "stepping down" and is explicitly permitted by §61.23.

Q: What should I do if I'm not sure whether a medical condition will affect my certificate?

The FAA strongly recommends using the AMAS (Aviation Medicine Advisory Service) or consulting with a HIMS AME (Human Intervention Motivation Study Aviation Medical Examiner) before submitting your medical application if you have any conditions of concern. An improperly answered MedXPress form can result in enforcement action even if the underlying condition would not have been disqualifying. Honesty and proactive disclosure are always the right approach.

Frequently Asked Questions