Quick Answer
- Three classes of FAA medical certificates exist: 1st Class (airline pilots), 2nd Class (commercial), and 3rd Class (private/student) — each with different requirements and validity periods
- The exam costs $80-$200 and is performed by an FAA-designated Aviation Medical Examiner (AME), typically taking 30-60 minutes
- Common disqualifying conditions include certain heart conditions, epilepsy, substance dependence, and bipolar disorder — but many conditions can be addressed through the Special Issuance process
- BasicMed provides an alternative to traditional FAA medicals for many private pilots, requiring only a state driver's license and physician exam
The aviation medical exam is a required step for most pilot certificates, and it causes more anxiety among prospective students than almost any other part of the training process. The good news: the vast majority of applicants pass, many common medical conditions are accommodable, and alternatives like BasicMed and the Sport Pilot driver's license option provide pathways for those with medical challenges.
The medical standards for all classes are codified in federal regulation, according to 14 CFR Part 67, current edition, which prescribes vision, cardiovascular, neurological, and mental health requirements administered by the FAA Aerospace Medical Certification Division.
Medical Certificate Classes
1st Class Medical
Required for: Airline Transport Pilot (ATP) privileges Validity: 12 months if under 40, 6 months if 40 or older Standards: Most stringent — includes ECG at age 35 and annually after 40
2nd Class Medical
Required for: Commercial pilot privileges (flying for compensation) Validity: 12 months Standards: Moderate — similar to 1st Class without ECG requirement until clinically indicated
3rd Class Medical
Required for: Private pilot, recreational pilot, student pilot (for solo) Validity: 60 months if under 40, 24 months if 40 or older Standards: Least stringent of the three traditional classes
Each class corresponds to a subpart of 14 CFR Part 67, and applications must be filed electronically via FAA Form 8500-8 through the MedXPress portal (Source: FAA MedXPress Instructions 2025).
BasicMed (Alternative)
Required for: Those who have held an FAA medical at any time after July 14, 2006 Validity: 48 months (physician exam every 48 months, online course every 24 months) Restrictions: Aircraft up to 12,500 lbs, up to 7 occupants (6 passengers), below 18,000 feet, under 250 knots, U.S. only
The BasicMed final rule was expanded effective November 18, 2024, raising the aircraft weight cap to 12,500 lbs and increasing the allowed passenger count to six, according to FAA BasicMed 2024 final rule.
Sport Pilot (Driver's License)
Required for: Sport pilot privileges only Validity: As long as your driver's license is valid Note: If you have been denied an FAA medical, you cannot use the driver's license option
What the Exam Covers
The AME examination includes:
Vision: Distance visual acuity (20/20 for 1st Class, 20/40 for 2nd and 3rd Class — corrective lenses permitted), near vision (20/40), color vision testing.
Hearing: Conversational voice test at 6 feet, or pure-tone audiometry. Hearing aids are permitted.
Cardiovascular: Blood pressure measurement, pulse rate, heart auscultation. ECG for 1st Class at age 35+ and when clinically indicated.
Respiratory: Lung auscultation, breathing assessment. No spirometry required unless clinically indicated.
Neurological: Basic neurological assessment, equilibrium testing.
Mental health: General mental health screening through interview. History of psychiatric conditions, substance use, and psychological stability.
General physical: Height, weight, general appearance, musculoskeletal assessment, abdominal exam.
The detailed standards each AME applies during this exam are published in the FAA Guide for Aviation Medical Examiners, which the FAA updates throughout the year.
Common Conditions and Their Impact
Generally Not Disqualifying
- Corrected vision (glasses, contacts, LASIK/PRK)
- Mild hearing loss (hearing aids accepted)
- Controlled high blood pressure (many medications approved)
- Well-managed diabetes (Type 2 with stable control)
- History of kidney stones (if resolved)
- Mild allergies and asthma (if controlled)
May Require Special Issuance
- ADHD (treated or past diagnosis)
- Depression (current or past, especially if on medication)
- Sleep apnea (treatable, documentation required)
- Heart conditions (case-by-case evaluation)
- Diabetes requiring insulin (possible with monitoring program)
- Past substance abuse (requires demonstrated recovery)
Generally Disqualifying (Difficult to Overcome)
- Epilepsy (seizure within past 10 years)
- Bipolar disorder
- Psychosis or severe personality disorders
- Active substance dependence
- Certain cardiac conditions (aortic aneurysm, certain arrhythmias)
- Insulin-dependent diabetes (was disqualifying, now possible via Special Issuance)
In 2024 the FAA updated guidance allowing immediate AME issuance for airmen with up to two specified "uncomplicated" anxiety or depression conditions, according to AOPA Pilot Protection Services 2024. This was a meaningful liberalization of historical FAA mental health policy.
The Special Issuance Process
If you have a condition that does not meet normal certification standards, the FAA may issue a Special Issuance (SI) medical certificate, as authorized under 14 CFR 67.401. This process involves:
- AME identifies the condition during your exam
- FAA requests additional documentation (medical records, specialist reports, testing)
- You provide the requested information to the FAA Aeromedical Certification Division
- FAA reviews and decides — approval, denial, or request for more information
- If approved, your medical certificate may have conditions or require periodic re-evaluation
The Special Issuance process typically takes up to six months and some applications stretch longer when the FAA requests additional records (Source: FAA AME Guide — Special Issuance). Working with an AME experienced in your specific condition improves outcomes.
Tips for a Successful Medical Exam
- Do NOT apply for a medical if you think you may be denied — a denial goes on your permanent record and complicates future applications. Consult with a knowledgeable AME first.
- Bring all medications you currently take (or a complete list with dosages)
- Bring relevant medical records for any conditions you want to discuss
- Be honest — falsifying a medical application is a federal crime
- Get adequate sleep and avoid caffeine before the exam (affects blood pressure)
- Consider a consultation with an aviation medical examiner before your formal exam if you have concerns about specific conditions
- Use AOPA's medical services for pre-application consultation if you have a complex medical history (see AOPA Medical Resources)
Cost and Where to Find an AME
The exam costs $80-$200 depending on the AME and the class of medical requested. Find designated AMEs through the official FAA AME Locator, which lets you search by ZIP code, city, or state. Most AMEs are family physicians, internal medicine doctors, or occupational medicine specialists with additional FAA certification.
FAQ
How hard is it to pass the aviation medical exam?
The vast majority of applicants pass. The exam is not physically demanding — it is a standard medical evaluation. Most healthy adults with corrected vision and no serious medical conditions pass easily. The most common issues are undiagnosed conditions discovered during the exam (elevated blood pressure, vision deficits, color vision).
Can I fly with glasses or contacts?
Yes. Corrective lenses are fully accepted for all classes of medical certificates. Your medical certificate will note "must wear corrective lenses." LASIK and PRK are also accepted — wait the required healing period before the exam.
What if I take antidepressants?
The FAA has an established process for certifying pilots on certain SSRI medications (originally sertraline, fluoxetine, citalopram, and escitalopram). The approved list was expanded in 2023 and 2024 to include bupropion, duloxetine, venlafaxine, and desvenlafaxine, according to AOPA Special Issuance Certification guidance. You must demonstrate stable treatment on a single dose, and the process requires additional documentation and evaluation.
Should I get my medical before starting flight training?
Yes, especially if you have any medical conditions that might be questioned. Getting your medical first confirms you can complete training. However, for Sport Pilot privileges, you can use a driver's license instead.
What is BasicMed and should I use it?
BasicMed allows pilots who have previously held an FAA medical to fly without a traditional medical certificate. You need a physician exam every 48 months and an online course every 24 months. BasicMed is ideal for private pilots with medical conditions that make traditional certification difficult but who can still safely fly.
Related Reading
- Student Pilot Certificate: Requirements and How to Apply
- Sport Pilot License: The Fastest Path to Flying
- Private Pilot License (PPL): Requirements, Timeline, and Cost
-- The Flight School Finder Team