FAA Medical Certificates Explained: First, Second, Third Class and BasicMed

The FAA has three classes of medical certificate and one alternative that is not a certificate at all. First Class is what an ATP needs; Second Class covers commercial privileges; Third Class covers private and student flying; and BasicMed lets many private pilots fly on a driver’s licence and a physician’s checklist instead. The durations depend on your age and on what you are doing that day, which is where most of the confusion lives.

The three classes

A higher class always covers the lower ones. Everyone starts on the same form, MedXPress (FAA Form 8500-8), filled in online before the AME visit; the AME examines you and either issues the certificate on the spot, defers to the FAA, or denies.

How long each one lasts

A medical does not expire; it downgrades. A First Class certificate keeps First Class privileges for a period, then serves as a Second Class, then a Third Class, until the Third Class period runs out. Under 14 CFR 61.23(d), counted in calendar months from the month of the exam:

So a 30-year-old’s First Class exam gives First Class privileges for 12 months, Second Class for 12 months, then Third Class privileges until 60 months after the exam. A 45-year-old airline pilot renews every 6 months. “Calendar month” means to the end of the month: an exam on 3 March 2026 with a 12-month period is good through 31 March 2027.

BasicMed

Since 2017 (14 CFR Part 68), a pilot who has held any FAA medical after 14 July 2006 can fly certain operations without a current medical certificate by holding a valid US driver’s licence, having a physical examination by any state-licensed physician using the FAA checklist every 48 months, and completing the free online BasicMed course every 24 months. Limits: aircraft of no more than six occupants and 6,000 lb maximum takeoff weight — raised by the 2024 FAA Reauthorization Act to seven occupants and 12,500 lb, check the current Part 68 text — below 18,000 ft, no faster than 250 knots, within the US, and not for compensation or hire (with narrow exceptions such as flight instruction for which the instructor is paid). BasicMed never qualifies you for commercial or ATP privileges, and a pilot whose last medical was denied or revoked must first obtain a new special-issuance medical.

What the exam involves

Vision (distant 20/20 corrected for First and Second Class, 20/40 for Third; near vision; colour vision — with alternatives like a light-gun test if you fail the plates), hearing (conversational voice at six feet or audiometry), blood pressure, urinalysis, a general physical and the medical history you declared on MedXPress. First Class adds an ECG at the first exam after age 35 and every year from 40. There is no blood test. Fees are set by the AME, typically USD 100–200.

Common problems and special issuance

Most disqualifying conditions in 14 CFR 67 — diabetes treated with insulin, certain heart conditions, a history of substance dependence, some psychiatric diagnoses and medications, ADHD history, sleep apnoea — can still lead to a certificate through Special Issuance (SI) under 67.401, with documentation and often periodic reporting. The two rules every applicant should know: declare everything — the FAA cross-checks and an omission is worse than the condition — and see an AME (or an aviation medical consultant) before you apply if anything in your history is complicated, because a deferral or denial is a long road back and closes the BasicMed door. The FAA’s CACI (Conditions AMEs Can Issue) list lets AMEs issue on the spot for many stable conditions, from well-controlled hypertension to treated hypothyroidism.

For airline careers

Get the First Class before you spend on training — a Third Class is enough to fly, but only the First Class tells you the career is open. Keep the ECG history clean, disclose consistently across every renewal, and note that airlines add their own medical screening at hiring (Delta and United among them) on top of the FAA certificate. A European Class 1 does not substitute: converting to the FAA means a new exam with an AME. See FAA vs EASA.

Common questions

How long is an FAA first class medical valid? For ATP privileges: 12 calendar months if you were under 40 at the exam, 6 months if 40 or over. It then continues as a Second Class (12 months) and a Third Class (60 or 24 months from the exam) before it runs out.

What medical do I need to be an airline pilot? A First Class medical certificate, issued by an FAA Aviation Medical Examiner, for Part 121 flying as PIC or SIC. It includes an ECG at the first exam after 35 and annually from 40.

What is BasicMed? An alternative to the Third Class medical under 14 CFR Part 68 for private-type flying: a US driver’s licence, a physician exam on the FAA checklist every 48 months and an online course every 24 months, with limits on aircraft size (six occupants and 6,000 lb, expanded by the 2024 Reauthorization Act), altitude (below 18,000 ft), speed (250 kt) and no flying for hire. You must have held an FAA medical after 14 July 2006.

Can I fly with glasses? Yes. Vision is corrected to 20/20 distant for First and Second Class and 20/40 for Third Class; the certificate carries a limitation to wear corrective lenses. Colour-vision failures on the plates can be resolved with alternative tests such as the light-gun signal test.

What disqualifies you from an FAA medical? The conditions listed in 14 CFR 67 — including insulin-treated diabetes, certain cardiac conditions, epilepsy, substance dependence, psychosis and bipolar disorder — are disqualifying for standard issuance, but many can be certified through Special Issuance with documentation. Declare everything and consult an AME before applying if your history is complicated.