Pilot health constitutes a crucial safety element in aviation.

Most aviators require some proof of medical fitness to exercise the privileges of their airman certificate, which often entails passing a medical exam and meeting specific medical standards.

The pilot medical certification in the U.S. falls into three categories: FAA medical certificate, U.S. driver’s license, or BasicMed.

Which one do you need? It depends on the type of your pilot certificate.

Ready to learn about one of the most important aspects of your life as a pilot?

Let’s start with the basics first.

What is an FAA Medical Certificate?

An FAA airman medical certificate is “acceptable evidence of physical fitness on a form prescribed by the Administrator.” It’s an official document issued by an FAA-designated Aviation Medical Examiner (AME) to demonstrate that you meet the appropriate medical standards to exercise the privileges of your pilot certificate.

Obtaining the certificate entails passing a medical exam, also known as flight physical, and meeting certain medical requirements.

Do Pilots Need a Medical Certificate?

The FAA requires most pilots to have their medical certificate on their person or in the aircraft. Here’s a list of the types of airmen required to hold a medical certificate:

• Airline transport, commercial, private, recreational, and student pilots.
• Flight instructor certificate (when serving as a pilot in command or a required flight crewmember).
• Flight engineers, flight navigators, and air traffic control tower operators.

However, the medical certificate isn’t required if you’re one of the following:

• Any pilot or flight instructor in a balloon or glider.
• Examiner, check airman, or examinee during a practical test or proficiency check in a glider, balloon, flight simulator, or flight training device.
• Ground instructors.
• Drone pilots.
• Pilots exercising private pilot privileges under BasicMed.
• S. Armed Forces military pilots (with certain limitations).

You may also use a U.S. driver’s license or a medical certificate if you’re a student, sport pilot, flight instructor, or examiner in light-sport aircraft.

Moreover, A U.S. driver’s license suffices if you’re a student, recreational, or private pilot, or flight instructor (acting as the pilot in command or as a required flight crewmember) if the aircraft, flight, and pilot meet certain conditions and limitations.

How do you get a pilot medical certificate, though?

Getting Your FAA Airman Medical Certificate

In the United States, you must follow these steps to get your FAA medical certificate:

• Complete the initial portion of your application on MedXPress.
• Book an appointment with an Aviation Medical Examiner (AME).
• Pass the medical examination (your AME will complete the rest of your application).
• Get your medical certificate if you meet the medical standards.

Sound good?

Let’s talk about the medical exam before we explore the medical certificates in more detail.

What Happens in an FAA Pilot Medical Exam?

First, you need to find an FAA AME and book an appointment. You may ask fellow pilots or flight instructors for recommendations, or you could use the FAA’s “Find an Aviation Medical Examiner” portal to locate an AME.

The examiner often starts the exam with questions about your recent medical history, including any hospital visits, surgeries, or medications.

The medical exam consists of a series of tests, examining your vision, hearing, blood pressure, pulse, urine, and general health among other areas. It may include an ECG if you’re 35 years of age and older and applying for a first-class medical certificate.

Moreover, the AME will ask questions about your mental health to determine your psychological fitness.

How long does it take to complete your medical exam?

Generally, your medical exam takes between 15 and 30 minutes if you have no medical condition or irregularities during the exam (e.g., high blood pressure).

What to bring to your medical exam?

You should bring the following items to your flight physical:

• Proof of age and identity (e.g., driver’s license or passport).
• Last medical certificate.
• Contact lenses or glasses.
• Your total and past 6-month flight time (logged or estimated).
• If you have any medical conditions, you should also provide history and treatment, pertinent medical records, current status report, and medication.

Medical Exam Cost

The FAA doesn’t publish a fixed examination fee, instead, it recommends that the fee should be usual and customary. The cost varies depending on the examiner, location, and class of medical certificate. Most AMEs charge $75 to $150 per exam, and a first-class medical examination can cost up to $200.

Medical Exam Outcomes

Your AME may issue, defer, or deny your application for a medical certificate:

Issuance

Your examiner should issue a medical certificate if you meet the required medical standards for the class.

Deferral

Your AME should defer your application to the FAA for action if they have any concerns about your medical eligibility or history.

Denial

The examiner will deny certification if the applicant clearly doesn’t meet the medical standards. It is a rare occurrence, though, denial accounts for roughly 0.1 percent of more than 450,000 applications for the FAA medical certificate annually.

However, An AME’s denial of a medical certificate is not a final FAA denial. You may appeal the examiner’s decision by submitting a request for consideration to the FAA’s Aerospace Medical Certification Division.

Medical Exam Tips

Here are a few tips to get you through your medical examination seamlessly:

Pick an experienced AME

A medical examiner who does hundreds of exams each year can help you navigate the application, examination, and regulation nuances. Ask around for recommendations and check online for reviews.

Prepare for the exam

Get enough sleep, keep yourself hydrated, and avoid any food or beverage that’s high in caffeine, sodium, or sugar and stay away from tobacco and stimulants for eight hours before your medical exam.

Bring the appropriate documents and items

Make sure you have all the pertinent items, such as your photo ID, medical records, and corrective lenses. Generally, the more documentation available, the faster the certification process.

Take the exam early

Don’t wait until the last few days before your medical certificate expires to complete your exam. You may not be able to schedule an appointment with an AME for some reason.

Build a long-term relationship with your AME

An AME who’s familiar with you and your medical history makes for smooth medical examination and certification. Find an examiner you’re comfortable with and stick with them.

So, you know what to expect and how to prepare for your medical exam.

Let’s discuss the medical certificate classes.

FAA Medical Certificate Classes

Medical certificates for pilots come in three classes: first, second, and third.

Each class has its standards and requirements, which include thresholds for vision, hearing, and blood pressure. Moreover, all classes require having no diagnosis, medical history, medication, or treatment for certain health conditions, diseases, and defects that may interfere with the person’s ability to fly safely.

Here’s a summary of the medical requirements for each class:

Class	First	Second	Third
Eye	Normal fields of vision with no acute or chronic pathological condition of either eye that interferes with the proper function of an eye   And Minimum visual acuity in each eye separately, with or without corrections as follows
Distant Vision	20/20		20/40
Intermediate Vision   (32 inches)	20/40 (age 50 and older)		No requirement
Near Vision   (16 inches)	20/40
Color Vision	Colors necessary for safe operation
Hearing	Demonstrate an ability to hear 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 an acceptable understanding of speech as determined by audiometric speech discrimination with a score of at least 70 percent obtained in one ear or in a sound field environment Or Provide acceptable results of pure tone audiometric testing of unaided hearing acuity
Ear, Nose, Throat (ENT)	No disease or condition that interferes with flying or clear and effective speech communication, or can cause vertigo or a disturbance of equilibrium
Blood Pressure	No specific value, but current guideline maximum is 155/95
Electrocardiogram (ECG)	At age 35 and annually after 40	No requirement
Mental Health	No diagnosis of psychosis, or bipolar disorder, or severe personality disorders

First Class

A first-class medical certificate is a requirement for airline transport pilots. It has the most stringent medical standards.

Second Class

The FAA designates the second-class medical certificate for commercial pilots. It has the same medical standards required for the first, but with one exception:

You’re not required to conduct an electrocardiogram.

Third Class

The third-class medical certificate is the minimum certification for student, recreational and private pilots. It’s quite similar to the second, but your vision doesn’t have to be as sharp.

Distant vision must be 20/40 or better and there’s no requirement for intermediate vision.

You’re familiar with the classes, but how long is an FAA medical certificate good for?

FAA Medical Certificate Validity

Medical Certificate	Airman	Age (on or before the date of examination)	Validity (in calendar months)
First Class	Airline Transport Pilot	40 or over	6
		Below 40	12
Second Class	Commercial Pilot	Any	12
Third Class	Private, Recreational, and Student Pilots	40 or over	24
		Below 40	60

The validity of your medical certificate depends on two factors: Age and operation type.

See, you may exercise the privileges of a lower airman certificate, which changes the validity period.

Here’s an example:

Suppose you’re an airline pilot with an ATP certificate. In this case, your medical certificate is valid for 6 months if you’re age 40 or older. However, the validity period becomes 24 months if you’re exercising private pilot privileges. Say, flying a Cessna 150 to a nearby island on weekends.

Got it?

Good, but you should know that many medical conditions would render you ineligible for a medical certificate.

FAA Medical Certificate Disqualifying Conditions

The FAA considers the following 15 medical conditions as disqualifying from obtaining a pilot medical certificate:

1. Angina pectoris

Chest pain or discomfort due to the heart’s arteries inability to deliver enough blood to the heart, which usually happens because one or more of the arteries is narrowed or blocked.

2. Bipolar disease

A mental health condition that causes extreme mood swings, which range from depression to mania. It causes changes in sleep, energy, and behavior.

3. Cardiac valve replacement

A replacement of one or more aortic valves with a mechanical valve or a biological valve made from cow, pig, or human heart tissue.

4. Coronary heart disease that has been treated or, if untreated, that has been symptomatic or clinically significant

A heart disease where the coronary arteries become too narrow or blocked, reducing the blood flow to the heart.

5. Diabetes mellitus requiring hypoglycemic medications

A medical term (commonly known as diabetes) that describes several metabolic disorders that cause high blood sugar.

6. Disturbance of consciousness without satisfactory explanation of cause

Impaired or complete loss of consciousness can lead to partial or total incapacitation, which poses obvious safety hazards.

7. Epilepsy

A neurological disorder in which brain activity becomes abnormal, causing unprovoked, recurrent seizures.

8. Heart replacement

A transplant surgery which replaces a damaged or failing heart with a healthy one from an organ donor.

9. Myocardial infarction

A medical term for a heart attack, which occurs when blood flow decreases or stops to a part of the heart.

10. Permanent cardiac pacemaker

A medical device that generates electrical impulses delivered to cause the heart muscle chambers to maintain an adequate heart rate.

11. Personality disorder that is severe enough to have repeatedly manifested itself by overt acts

A mental disorder characterized by inflexible and atypical patterns of thinking, feeling, and behaving.

12. Psychosis

A mental disorder that causes difficulties in the perception or interpretation of reality with the possible occurrence of hallucinations or delusions among other symptoms.

13. Substance abuse

Harmful use or misuse of alcohol, medication, or drugs, which makes the person unable to fly safely. The FAA also defines substance abuse as a verified positive drug test result, an alcohol test result of 0.04 or greater alcohol concentration, or a refusal to submit to a drug or alcohol test.

14. Substance dependence

A condition in which a person is dependent on a substance other than tobacco or ordinary xanthine containing (e.g., caffeine) beverages.

15. Transient loss of control of nervous system function(s) without satisfactory explanation of cause.

The temporary loss of one or more of nervous system functions, for example, the ability to control movement.

Other medical conditions can also be temporarily or permanently disqualifying, such as acute infections or physical defects that may interfere with safe flight.

However, the FAA may grant special issuance based on individual considerations.

Special Issuance and SODA

Can you obtain a medical certificate even if you suffer from a disqualifying condition?

Yes, you may be eligible for a discretionary issuance of a certificate.

The FAA’s medical division reviews cases, often requiring more documents than what’s usually requested, including doctor’s report, medical records, and blood tests to determine the applicant’s eligibility for a special issuance of a medical certificate.

A special issuance is an authorization granted by the FAA, at the discretion of the Federal Air Surgeon, to applicants who don’t meet medical standards for the first, second, or third class.

You may have to pass a special medical flight test, practical test, or medical evaluation to obtain the authorization. You must also show that you’re able to perform your airman duties authorized by the class of medical certificate sought without endangering public safety. The authorization is valid for a limited duration and requires renewal.

Renewing your special issuance requires going through an AME Assisted Special Issuance (AASI).

An AASI is a process that permits examiners to re-issue an airman medical certificate based on an authorization to pilots with disqualifying medical conditions if the applicant provides the requisite medical information. The AME’s decision is subject to review by the FAA.

On the other hand, a Statement of Demonstrated Ability (SODA) is a statement authorizing medical certification of, at the discretion of the Federal Air Surgeon, applicants whose disqualifying condition is static or non-progressive. You must also prove your capability of flying safely through the successful completion of a practical test. A SODA doesn’t expire.

Both provisions authorize a designated AME to issue a medical certificate of a specified class if the condition hasn’t adversely changed.

Special issuance, SODA, and the medical certificate may state operational limitations for safety.

This brings us to the next point.

FAA Medical Certificate Limitations and Restrictions

Limitations placed on a medical certificate are essentially prerequisites for pilots who don’t meet the minimum medical standards for the class. A common limitation is “Must wear corrective lenses” for pilots who need glasses or contacts to achieve the required visual acuity.

The FAA language uses restrictions and limitations interchangeably, but restrictions are often limitations on the airman’s operational privileges or validity period of the medical certificate. Here are a few examples:

• Second class privileges limited to aerial application
• Valid for and limited to air traffic control duty only
• Valid for 9 months following the month examined

Pilots with color vision deficiencies, including color blindness, typically have the “Not valid for night flying or by color signal control” restriction on their medical certificate.

Next, let’s delve into the latest addition to medical certification.

BasicMed

BasicMed is an alternate way for pilots to demonstrate medical eligibility to fly without holding an FAA medical certificate.

It came into effect in May 2017, and now years later, more than 60,000 pilots fly under the regulatory relief.

Who can fly under BasicMed?

Student, recreational, and private pilots, in addition to flight instructors when acting as pilot in command (PIC).

BasicMed Requirements

Here’s a summary of what you need to fly under BasicMed:

• Hold a current and valid U.S. driver’s license and comply with all medical requirements or restrictions associated with it.
• Hold or have held a medical certificate (including special issuance) issued by the FAA after July 14, 2006.
• Have not had the most recent medical certificate revoked, suspended, or withdrawn.
• Have not had the most recent application for airman medical certification completed and denied.
• Answer the health questions on the Comprehensive Medical Examination Checklist (CMEC).
• Get your physical examination by any State-licensed physician, using the Comprehensive Medical Examination Checklist (CMEC).
• Complete the Mayo Clinic’s or AOPA’s BasicMed online medical education course.

BasicMed Privileges and Limitations

BasicMed allows you to exercise the privileges associated with a third-class medical certificate, but with the following limitations:

• Aircraft must have a maximum certificated takeoff weight of no more than 6,000 lbs.
• Aircraft authorized to carry no more than 6 occupants (5 passengers).
• Operating under VFR or IFR, with the U.S., below 18,000’ MSL, at speeds not exceeding 250 knots.
• Flight not conducted for compensation or hire.

BasicMed Renewal

BasicMed’s validity differs from a medical certificate’s. While the latter’s expiry depends on the age and type of operation, keeping your BasicMed valid requires meeting the following:

1. Hold a current and valid U.S. driver’s license.
2. Pass a medical examination and have your Comprehensive Medical Examination Checklist (CMEC) completed by a state-licensed physician every 48 months.
3. Complete an FAA-approved online BasicMed medical education course and receive a completion certificate every 24 months.
4. Keep the CMEC and course completion certificate to provide to the FAA upon request.

You must also have passed a flight review within the past 24 months to exercise the privileges of your pilot certificate. Therefore, a valid and current flight review is a requirement to fly under BasicMed.

Now let’s answer a few common questions.

FAA Medical Certificate FAQs

Can pilots wear glasses or contact lenses?

Yes, you may wear corrective lenses (glasses or contacts) if you’re a pilot, but you should always carry a spare pair when flying. You can also get LASIK eye surgery, although you should consult an AME prior.

How long does it take to get an FAA medical certificate?

Normally, you’d receive your medical certificate upon the conclusion of your medical exam, which takes no more than 30 minutes in most cases. However, it may take days, weeks, or even months if you’re applying for special issuance medical certificate.

Is there an age limit for obtaining a medical certificate?

There are no minimum or maximum ages, you’re eligible for it as long as you pass your medical exam. However, because 16 years of age is required for the issuance of a student pilot certificate, any applicant below that age would have no use for a medical certificate.

How to replace a lost pilot medical certificate?

You can request a permanent replacement certificate online or by mail, which costs $2 and takes up to 10 days for online processing and 6 weeks for mail processing. You could also receive a temporary medical certificate by contacting the Aerospace Medical Certification Division (AMCD) call center. You’d often receive it the same day via fax or email and it’s valid for 60 days.

Can you be a pilot with a medical condition?

Yes, you can become a pilot if your condition is adequately controlled and you’re able to demonstrate that it won’t affect your ability to fly safely. Some conditions are initially disqualifying, but the FAA may still grant you a medical certificate under the provision of special issuance.

IMSAFE Checklist

IMSAFE is a mnemonic recommended for pilots to determine physical and mental readiness for flying. Here’s what each letter stands for:

• Illness
• Medication
• Stress
• Alcohol
• Fatigue
• Emotion

Each of these elements can impair your judgment, which may bring about deadly safety hazards.

You should make sure that none of them is affecting you before every flight. It’s recommended to avoid alcohol for at least 8 hours before you fly, although many airlines require a minimum of 12.

Stress and emotion can be tough to eliminate, but try your best to manage them.

Conclusion

Apart from the regulations, you’re ethically and legally responsible for flying only when you’re fit to operate an aircraft safely without endangering the public, passengers, crew, or yourself.

You must always ensure that your proof of medical fitness is valid and current, be it an FAA medical certificate, U.S. driver’s license, or BasicMed.

You must also comply with all limitations or restrictions associated with your certification.

Poor health, fatigue, or stress may cause errors in judgment with catastrophic consequences.

Pay close attention to your mental and physical health, and never hesitate to see a doctor if you’re feeling unwell.

Make sure you’re in good shape through a healthy diet, regular exercise, and adequate sleep.

Being a healthy, medically fit pilot is a lifestyle.