FAA Medical Certificate Classes: First, Second, Third & BasicMed

The FAA issues three classes of pilot medical certificate, and the one you need depends on the flying you plan to do. A first-class medical certificate covers airline transport pilots, a second-class covers commercial pilots, and a third-class covers private, student, recreational, and sport pilots along with flight instructors acting as pilot-in-command.¹ Standards get stricter as you move up, and validity runs from as little as six months to as long as 60 months depending on the class and your age.

First-Class Medical Certificate

A first-class certificate is what you need to exercise airline transport pilot privileges: pilot-in-command of an airline, second-in-command in certain multi-crew Part 121 operations, or required crewmember in airline operations after your 60th birthday.¹

Vision is strict. Distant visual acuity must be 20/20 in each eye, corrected or uncorrected. Near vision must be 20/40 or better at 16 inches, and at age 50 an additional 20/40 test at 32 inches applies so the FAA can be confident you can still read instruments and charts at arm’s length.² Corrective lenses are allowed, but they become a limitation printed on the certificate, meaning you must wear them when you fly.

Hearing is tested by your ability to hear an average conversational voice in a quiet room at six feet with your back turned to the examiner, or by an approved audiometric test.²

Cardiovascular screening is where first-class truly separates itself. You need a baseline electrocardiogram at your first exam after turning 35, then annually after age 40.² Second- and third-class applicants are not required to get routine ECGs at all, though an examiner can always order one if something turns up during the physical.³

For airline transport privileges, a first-class certificate lasts 12 months if you’re under 40, and just six months if you’re 40 or older.⁴ That six-month window is the shortest validity period in the system.

Second-Class Medical Certificate

A second-class certificate is required for exercising commercial pilot privileges in powered aircraft, and also for flight engineer and air traffic control tower operator duties.¹ The broader universe of flying-for-hire work sits here: charter flights, banner towing, aerial surveying, crop dusting, and similar operations that don’t rise to airline transport.

Vision standards match first-class: 20/20 distant and 20/40 near at 16 inches in each eye, with the added 32-inch near test starting at age 50.⁵ Hearing and mental health standards also mirror first-class. The main practical difference is cardiovascular: no routine ECG is required at any age, which usually makes the exam simpler and cheaper.

A second-class certificate is valid for 12 months for commercial operations, regardless of age.⁴

Third-Class Medical Certificate

Private pilots, student pilots, recreational pilots, and flight instructors acting as pilot-in-command need at least a third-class medical certificate, unless they qualify for BasicMed.¹ This is the entry-level tier, and the standards reflect the lower-risk profile of personal flying.

The visible difference is the vision threshold. Distant acuity only needs to be 20/40 in each eye instead of 20/20. Near vision, hearing, and mental and neurological standards still apply, and the examiner screens for conditions like epilepsy, psychosis, bipolar disorder, and substance dependence just as rigorously as at higher tiers.⁶

Validity depends on age. Under 40, a third-class certificate lasts 60 calendar months (five years). At 40 or older, the window shrinks to 24 months.⁴

How a Higher Class Steps Down Over Time

A medical certificate doesn’t switch off on a single date. It steps down through privilege levels as it ages. A first-class certificate grants airline transport privileges for 12 months (or six months at age 40 and older), then keeps authorizing commercial operations through month 12 from issuance, then private-pilot operations for up to 60 months if you’re under 40 or 24 months if you’re 40 or older.¹

The same logic applies to a second-class certificate. After the 12-month commercial window closes, it continues to serve as a third-class for private flying. A professional pilot whose first- or second-class medical lapses doesn’t lose all flying privileges overnight; they just can’t fly commercially until they renew.

BasicMed as an Alternative to Third-Class

Since 2017, many private pilots have been able to skip the traditional third-class medical certificate by using BasicMed. It lets you fly on a regular U.S. driver’s license with periodic check-ups from any state-licensed physician, rather than requiring an Aviation Medical Examiner.⁷

To qualify, you must have held an FAA medical certificate at some point after July 14, 2006.⁷ After that, you complete a comprehensive medical examination every 48 months and an online medical education course every 24 months. The course covers self-assessment, warning signs of serious conditions, and the risks of over-the-counter and prescription medications.⁸

BasicMed comes with limits. The aircraft can seat no more than seven occupants and must weigh no more than 12,500 pounds at takeoff. You’re limited to six passengers, can’t fly above 18,000 feet or faster than 250 knots, and cannot fly for compensation or hire.⁷ VFR and IFR are both allowed, but only inside the United States unless another country specifically authorizes it.⁹

One catch surprises people. If you have a history of certain conditions (psychosis, bipolar disorder, epilepsy, heart attack, coronary heart disease requiring treatment, or cardiac valve replacement), you must have already been through the FAA’s Special Issuance process for that condition before you can use BasicMed.⁸ BasicMed is not a way around a serious medical disqualification.

Conditions and Medications That Can Block a Certificate

Some conditions automatically disqualify you from any class of medical certificate: angina, coronary heart disease that has required treatment or produced symptoms, heart attack, cardiac valve or heart replacement, permanent pacemaker, epilepsy, unexplained loss of consciousness, psychosis, bipolar disorder, severe personality disorders, and substance dependence or abuse.¹⁰ Other conditions can also be disqualifying based on the examiner’s or the FAA’s judgment.

A disqualifying diagnosis isn’t necessarily permanent. Under the Special Issuance process, the Federal Air Surgeon can grant a time-limited authorization to a pilot who shows their condition is well-controlled enough to fly safely. You’ll usually submit medical records, undergo specialized testing, and sometimes complete a medical flight test. For a static, nonprogressive condition (a missing finger, for example, or stable vision loss in one eye), the FAA can instead issue a Statement of Demonstrated Ability, which does not expire and lets your AME issue certificates going forward without re-involving the FAA.¹¹

Medications matter too. The FAA maintains “Do Not Issue” drugs that block certification (including all controlled substances, most psychiatric medications, nitroglycerin, centrally acting blood pressure drugs like clonidine and methyldopa, and sympathomimetic weight-loss drugs) and “Do Not Fly” drugs that require grounding periods after each use (including first-generation antihistamines like diphenhydramine, muscle relaxants, opioid pain relievers, benzodiazepines, and all sleep aids). A blanket rule sits on top: if any medication you take, prescription or over-the-counter, carries a label warning about drowsiness or advises caution when driving or operating machinery, you cannot fly while using it.¹²

How You Apply and Get Examined

Every application starts with FAA MedXPress, the online portal where you complete Form 8500-8. You provide a full medical history covering hospitalizations, surgeries, chronic conditions, and every medication you currently take, plus every visit to a health professional in the past three years.¹³ You also disclose any alcohol-related driving offenses, substance-related arrests, and any prior denials or deferrals. Lying on this form is a federal crime under 18 U.S.C. § 1001, carrying a fine and up to five years in prison, and the FAA can revoke all of your pilot certificates on top of that.¹⁴

Once MedXPress gives you a confirmation number, you schedule the physical with an Aviation Medical Examiner. AMEs are physicians with specific FAA authorization to conduct pilot exams, and the FAA maintains an online locator.¹⁵ Expect blood pressure, urinalysis, vision including color vision, and a general physical. Blood pressure must not exceed 155/95, and if you’ve used antihypertensive medication in the past 30 days without prior FAA approval, the examiner will defer your application.¹⁶ Color vision is tested in person using an approved computer-based test; failing it doesn’t necessarily ground you but produces a limitation restricting certain operations.¹⁷

First-class applicants at the ECG ages have the electrocardiogram done during the visit, sometimes for an added fee. Exam fees vary by provider but typically fall between $75 and $250, with first-class at the higher end. When everything is in order, the AME issues the certificate at the appointment. If a condition needs further review, the examiner defers your application to the FAA’s Aerospace Medical Certification Division, and deferrals can run from a few weeks to several months depending on complexity and documentation. During a deferral, you cannot exercise the pilot privileges that require the class of medical you applied for.

1
eCFR. 14 CFR 61.23 – Medical Certificates: Requirement and Duration
2
eCFR. 14 CFR Part 67 Subpart B – First-Class Airman Medical Certificate
3
Federal Aviation Administration. AME Guide – When Is an ECG Required
4
eCFR. 14 CFR 61.23 – Medical Certificates: Requirement and Duration
5
eCFR. 14 CFR Part 67 Subpart C – Second-Class Airman Medical Certificate
6
eCFR. 14 CFR Part 67 Subpart D – Third-Class Airman Medical Certificate
7
Federal Aviation Administration. BasicMed
8
eCFR. 14 CFR Part 68 – Requirements for Operating Certain Small Aircraft Without a Medical Certificate
9
eCFR. 14 CFR 61.113 – Private Pilot Privileges and Limitations: Pilot in Command
10
Federal Aviation Administration. What Medical Conditions Does the FAA Consider Disqualifying
11
eCFR. 14 CFR 67.401 – Special Issuance of Medical Certificates
12
Federal Aviation Administration. Guide for Aviation Medical Examiners – Pharmaceuticals (DNI/DNF)
13
Federal Aviation Administration. Pilot Mental Fitness
14
Office of the Law Revision Counsel. 18 U.S. Code 1001 – Statements or Entries Generally
15
Federal Aviation Administration. Find an Aviation Medical Examiner
16
Federal Aviation Administration. AME Guide – Item 55. Blood Pressure
17
Federal Aviation Administration. AME Guide – Item 52. Color Vision