FAA Medical Certificate Requirements 2026 Class 1,2,3

The FAA medical certificate is one of the most misunderstood prerequisites in US flight training. Many prospective pilots delay starting their training because they have heard a story about somebody being denied a medical for a minor condition. In reality, the FAA medical certification system in 2026 is more accommodating than at any point in its history, the three certificate classes correspond to clear and predictable pilot career stages, and the application process is straightforward for the large majority of applicants. This guide explains exactly what a medical certificate is, the differences between First Second and Third Class, the AME exam process, validity periods, the BasicMed alternative, and how to prepare so your application moves smoothly.

 

What is the FAA medical certificate

The FAA medical certificate is a federal authorization that a pilot is medically fit to exercise the privileges of a pilot certificate at a specified class level. It is required for almost all pilot operations in the United States, with limited exceptions (BasicMed for certain PPL operations, glider, balloon and sport pilot operations).

The medical certificate is issued by the FAA Aerospace Medical Certification Division through a network of approximately 3,000 Aviation Medical Examiners (AMEs) who are private physicians authorized by the FAA to administer the medical exam.

The certificate is issued in one of three classes: First Class, Second Class or Third Class. The class corresponds to the highest level of pilot operations the certificate authorizes. A higher class also serves as a lower class. A Third Class medical does not serve as a Second or First Class. The differences are about the rigor of the medical exam, the conditions that are evaluated, and the validity period.

For the regulatory text, the FAA medical certificate is defined in 14 CFR Part 67. The full text is available at the federal eCFR website (eCFR Title 14 Part 67).

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The three classes of medical certificate

Third Class medical certificate

The most common entry level certificate for student pilots, private pilots, and instrument rated pilots flying for personal use or non commercial purposes.

What it authorizes: Student Pilot operations, Private Pilot operations, Instrument flying as PIC, Flight Instructor operations (for non commercial CFI activity).

Exam scope: Standard physical including vision, hearing, blood pressure, pulse, basic cardiovascular evaluation, urinalysis for diabetes screening, review of medications and medical history. No EKG required at initial issuance.

Validity period in 2026:

• 60 calendar months (5 years) if you are under age 40 at the time of exam.
• 24 calendar months (2 years) if you are age 40 or older at the time of exam.

Cost: $100 to $200 with most AMEs.

Best for: Student pilots beginning training, recreational and personal flying private pilots, instrument rated private pilots, CFIs who teach part time.

Second Class medical certificate

The standard certificate for commercial pilot operations that do not involve scheduled airline service.

What it authorizes: All Third Class privileges plus Commercial Pilot operations, including flying for hire as a non airline commercial pilot (charter, freight, agricultural, banner towing, helicopter EMS, helicopter tour, corporate, Part 135 single pilot).

Exam scope: Same as Third Class plus a more detailed cardiovascular evaluation and slightly stricter standards for some conditions.

Validity period in 2026:

• 12 calendar months for commercial privileges.
• 60 or 24 calendar months for Private Pilot privileges (same as Third Class rules, depending on age).

Cost: $125 to $250 with most AMEs.

Best for: Commercial pilots flying charter, freight, agricultural, helicopter EMS, helicopter tour, corporate, Part 135 single pilot, CFIs flying for compensation.

First Class medical certificate

The highest level certificate, required for airline transport pilot operations and for any pilot acting as PIC of a scheduled airline operation (Part 121) or certain Part 135 operations.

What it authorizes: All lower class privileges plus Airline Transport Pilot operations and PIC of Part 121 scheduled airline operations.

Exam scope: Same as Second Class plus an EKG at age 35 (initial) and annually thereafter, plus more rigorous evaluation of cardiovascular, neurological and psychological conditions.

Validity period in 2026:

• 12 calendar months for First Class privileges if you are under age 40.
• 6 calendar months for First Class privileges if you are age 40 or older.
• 12 calendar months for Second Class privileges.
• 60 or 24 calendar months for Third Class privileges, depending on age.

Cost: $150 to $350 with most AMEs (EKG fee adds $50 to $150 separately if not bundled).

Best for: Airline pilots (regional and major), pilots in the process of building hours toward an ATP certificate who want to start with the right class on file, Part 121 scheduled commercial operations.

Which class do you need at each career stage

Career stage	Recommended class	Why
Student Pilot starting training	Third Class	Lowest cost, longest validity, sufficient for PPL training
Career track student going zero to CPL	Third Class first, then Second Class	Start with Third for cost. Upgrade to Second after PPL or before CPL checkride
Working CFI building hours toward ATP	Second Class	Required for paid flight instruction with commercial privileges
First officer or captain at a regional airline	First Class	Required for Part 121 scheduled operations
Mainline major airline captain	First Class	Required, with 6 month renewal at age 40+
Recreational PPL only, age 40+	Third Class or BasicMed	BasicMed may be more cost effective for personal flying only
Helicopter tour or EMS pilot	Second Class	Standard for commercial helicopter operations

For Pelican's full program path, see Professional Pilot Program and from zero to CPL.

The AME exam process step by step

Understanding what actually happens in the AME's office takes most of the unknown out of the experience.

Step 1 Find an AME

Use the FAA's AME search tool (designee.faa.gov) to find an AME near you. AMEs are private physicians, so quality, bedside manner and pricing vary widely. Get a recommendation from your CFI or local flight school if possible. AMEs who regularly examine student and commercial pilots are usually faster and more efficient than AMEs who rarely see aviation patients.

Step 2 Complete the MedXPress application

Before your appointment, go to medxpress.faa.gov and complete FAA Form 8500-8 online. You will need:

• Personal identification (SSN, date of birth, address).
• Medical history (conditions, surgeries, hospitalizations, medications, mental health history).
• Substance use history (alcohol, drug, DUI/DWI history).
• Aviation history (pilot certificates, ratings, flight hours, prior medical certificates).

MedXPress saves your application and generates a confirmation number. Bring the confirmation number to your AME appointment.

Important: Be honest and complete on MedXPress. The FAA cross references answers against other federal databases (NDR for driving records, federal medical databases). Discrepancies between your MedXPress and other federal records trigger delays and sometimes denials.

Step 3 The exam

The exam typically takes 30 to 60 minutes and includes:

• Vision test (visual acuity, color vision, peripheral vision).
• Hearing test (conversational level, sometimes audiometer).
• Blood pressure and pulse.
• Cardiovascular exam (basic, EKG for First Class at 35+).
• Urinalysis (sugar and protein).
• General physical (height, weight, neurological screen).
• Medication and condition review with the AME.

Step 4 Issuance or deferral

In the large majority of cases (approximately 90% based on FAA data), the AME can issue the medical certificate at the end of the exam. You walk out of the office with a paper certificate that is immediately valid.

In approximately 10% of cases, the AME defers the application to the FAA Aerospace Medical Certification Division for further review. Deferral does not mean denial. It means the FAA wants additional medical records, specialist evaluations, or documentation before issuing. Deferral resolution typically takes 30 to 120 days.

Step 5 Carrying the certificate

The medical certificate is a paper document. Most pilots carry it folded with their pilot certificate. You must have the medical certificate available when acting as PIC. Many pilots also keep a scanned copy on their phone as a backup.

BasicMed an alternative for PPL and IR pilots

Introduced in 2017, BasicMed is an alternative medical certification pathway for PPL and IR pilots flying under specific limitations.

BasicMed limitations

• Aircraft maximum certified takeoff weight: 6,000 lbs.
• Maximum 6 occupants.
• Maximum 250 knots true airspeed.
• Maximum 18,000 feet MSL altitude.
• VFR or IFR operations only (not under Part 135 commercial).
• US operations only (some international acceptance, but limited).

BasicMed requirements

• Hold or have held an FAA medical certificate at any time after July 15, 2006.
• Complete an online medical education course every 24 calendar months.
• Have a comprehensive medical examination by any state licensed physician every 48 calendar months, documented on FAA Form 8700-2.

When BasicMed is the right choice

• Personal use PPL pilots who fly mostly under the BasicMed weight and altitude limits.
• Pilots over age 40 who want to avoid the 24 month FAA Third Class cycle.
• Pilots with a stable medical condition that the FAA accepts but requires extra paperwork to keep current.

When BasicMed is not the right choice

• Anyone training toward CPL, CFI for compensation, ATP or any commercial operation.
• Pilots who plan to fly large GA aircraft, jets, or above 18,000 feet.
• International student pilots whose home country authority does not recognize BasicMed.

For career track students at Pelican, the standard pathway is Third Class then Second Class then First Class. BasicMed is not part of the typical career pilot pathway.

Common conditions that require special handling

The FAA medical system in 2026 accommodates a wide range of medical conditions through specific protocols. The conditions below frequently come up in student pilot questions:

Color vision deficiency

The FAA tests color vision at the medical exam. A failed Ishihara test does not end your pilot dreams. Pilots who do not pass the standard test can request a Statement of Demonstrated Ability (SODA) by passing additional FAA approved color vision tests (such as the FALANT test) or by demonstrating in flight color signal recognition with an examiner.

Vision and glasses

The FAA accepts corrective lenses (glasses or contacts) for visual acuity. The visual acuity standards are 20/40 distant vision in each eye for Third and Second Class, 20/20 distant vision for First Class (corrected or uncorrected). Most pilots who need glasses are issued a medical certificate with the limitation "must wear corrective lenses for distant vision."

For more on flying with glasses, see pilot vision requirements glasses and fly with glasses.

High blood pressure

Treated and stable hypertension is generally acceptable at all medical classes, provided the medications used are on the FAA approved list. Most modern antihypertensive medications are acceptable.

Diabetes

Type 2 diabetes managed with diet, oral medications, or non insulin treatments is generally acceptable at all medical classes with appropriate documentation. Type 1 diabetes managed with insulin requires a Special Issuance medical, which is more involved but achievable.

Mental health conditions and medications

The FAA has revised its policies in recent years to accept certain antidepressants (SSRIs from the approved list) under specific conditions and with appropriate documentation. Conditions like depression, anxiety and ADHD are no longer automatic denials. Disclose all conditions and medications on MedXPress, and work with an AME experienced in mental health Special Issuance cases.

ADHD

ADHD diagnoses and medications require additional FAA review and typically a HIMS evaluation or equivalent. Successful Special Issuance for ADHD is achievable in 2026 with appropriate documentation and a stable medication regimen or documented period off medication.

DUI / DWI history

A DUI or DWI must be reported on MedXPress and to the FAA Security Division within 60 days of conviction. A single DUI is usually accommodated at all medical classes with documentation. Multiple DUIs or DUIs combined with substance use evaluation findings may require a HIMS evaluation and a Special Issuance medical.

Heart conditions

Cardiac history (heart attack, stents, bypass, valve replacement, atrial fibrillation) requires Special Issuance documentation but does not automatically disqualify. Many pilots fly with documented cardiac history through the FAA Special Issuance pathway.

How to prepare for your AME exam

The single biggest factor in a smooth AME exam is preparation.

• Review your medical history. Pull your records from your primary care physician, any specialists you have seen, and any hospitals where you have been admitted. Have dates, diagnoses, and treatments ready.
• Gather medication information. List every medication you take, prescription and over the counter, including dose and frequency. Check the FAA medications list (pilotmedicalsolutions.com/faa-medications-list) or with your AME for any medications that require special handling.
• Pull your driving record. The FAA cross references your driving record. Pull a copy and verify the dates and dispositions of any incidents.
• For First and Second Class, schedule a baseline cardiovascular exam with your primary care physician 30 to 60 days before your AME exam if you have any cardiovascular history. Walking into the AME with current cardiac documentation often prevents deferrals.
• For vision, get a current optometry exam if you have not had one in the past year. Confirm your corrective lens prescription is current.
• Hydrate normally and eat a normal meal before the exam. Avoid extreme caffeine or alcohol consumption in the 48 hours before, as these affect blood pressure and pulse.
• Bring documentation for any condition or medication you disclose on MedXPress. Letters from treating physicians, records of stable treatment, recent lab results.

What happens if your medical is denied or deferred

A denial is extremely rare for first time student pilot applicants. A deferral is more common.

If you receive a denial or deferral letter from the FAA:

• Read the letter carefully. It will specify what additional documentation, evaluation or testing the FAA wants.
• Schedule the requested evaluations promptly. Specialty evaluations (cardiology, neurology, psychiatry) often have 4 to 12 week wait times.
• Send all requested documentation to the FAA address specified in the letter, with a cover letter referencing your application.
• If the denial or deferral involves a complex medical history, consider engaging an aviation medical advocate (organizations like Pilot Medical Solutions, AOPA Pilot Protection Services, or the Aviation Medicine Advisory Service offer paid case management).
• The FAA's Special Issuance pathway is the most common route from initial deferral to eventual issuance.

For Pelican students specifically, our admissions team has worked with students through many medical certification scenarios and can recommend AMEs experienced in your specific situation. See admissions.

Frequently Asked Questions

What class of FAA medical do I need to start flight training?

A Third Class medical certificate is the minimum required for student pilot operations and PPL training. You can begin ground school and discovery flights without a medical, but cannot solo or take the PPL checkride without at least a Third Class.

How much does an FAA medical exam cost?

Typical costs in 2026: Third Class $100 to $200, Second Class $125 to $250, First Class $150 to $350. EKG (required for First Class at age 35+) may be billed separately at $50 to $150.

How long is a Third Class medical valid?

60 calendar months (5 years) if you are under age 40 at the time of exam. 24 calendar months (2 years) if you are age 40 or older at the time of exam.

How long is a First Class medical valid?

For First Class privileges: 12 calendar months under age 40, 6 calendar months age 40 and older. For Second Class privileges within the same certificate: 12 calendar months. For Third Class privileges: 60 or 24 months depending on age.

Can I fail an FAA medical for high blood pressure?

Treated and stable hypertension on FAA approved medications is generally acceptable at all classes. Uncontrolled hypertension at the exam (typically above 155/95 in 2026) may result in deferral until your blood pressure is stable.

Can I fly with glasses?

Yes. The FAA accepts corrective lenses for distant vision. You will be issued a medical certificate with the limitation "must wear corrective lenses for distant vision" if you require them to meet the visual acuity standard. See pilot vision requirements glasses.

Can I fly with ADHD or take ADHD medications?

ADHD requires Special Issuance documentation in 2026 but is not an automatic disqualification. Most successful applicants either demonstrate a stable medication regimen with documentation, or demonstrate a documented period off medication with neuropsychological testing. Work with an AME experienced in HIMS or mental health Special Issuance cases.

What is BasicMed and when should I use it?

BasicMed is an alternative medical pathway for PPL and IR pilots flying personal aircraft under 6,000 lbs, 6 occupants, 250 knots, and 18,000 feet MSL. It does not apply to commercial or airline operations. It is most useful for PPL pilots over age 40 who fly personal aircraft and want to avoid the 24 month Third Class renewal cycle.

What happens if my medical is deferred?

Deferral means the FAA wants additional documentation before issuing. It does not mean denial. Typical resolution time is 30 to 120 days. The FAA will send you a letter specifying exactly what is needed. Provide the requested documentation promptly and the application generally proceeds to issuance.

Should I see my regular doctor before the AME exam?

Yes if you have any chronic conditions or take regular medications. Walking into the AME with current documentation from your primary physician (current vitals, medication list, stable disease documentation) prevents most deferrals. For First and Second Class with cardiovascular history, also see a cardiologist for a baseline within 60 days.

Where can I read the actual FAA medical regulations?

The full regulatory text is in 14 CFR Part 67 at the federal eCFR website: eCFR Title 14 Part 67. Specific medical condition policies are documented in the FAA Medical Examiners Guide at the FAA Aerospace Medical Certification Division website.

Where to start

If you are beginning flight training, your two next steps are:

• Find an AME near you at designee.faa.gov.
• Complete MedXPress at medxpress.faa.gov before your appointment.

For Pelican specifically, the entry point is admissions or apply now. Our admissions team can recommend AMEs near our Pembroke Pines campus that frequently work with student pilots.

Author: Egor Kalachev, Chief Instructor at Pelican Flight Training. LinkedIn | /egor-kalachev

Editorial oversight: Capt E. Ray Poss, Chief Flight Instructor (59 years in aviation, 21,200+ hours, 4,000+ CFI hours).

Published 2026-05-27. Medical information is based on FAA regulations and policies as published in 14 CFR Part 67 and the FAA Aerospace Medical Certification Division materials available in May 2026. This article is educational and is not personalized medical advice. Always consult a qualified Aviation Medical Examiner for your specific medical certification situation.