The FAA medical, in plain English

When do you actually need one?

14 CFR 61.23(a)(3) requires at least a third-class medical certificate when you exercise the privileges of a student, recreational or private pilot certificate. While an instructor is on board, they are the one exercising pilot privileges. The moment you fly the aeroplane alone, you are, and you need the certificate before that flight.

In practice, book the exam in your first few weeks anyway — not because the rule demands it then, but because the worst version of this is discovering a complication after you have spent eight thousand dollars.

Which class do I need, and how long does it last?

Third class covers student, recreational and private pilot privileges. Second class is for commercial operations. First class is for airline transport pilots. You only ever need the class that matches what you are doing, and for learning to fly that is third.

14 CFR 61.23(d) sets how long a third-class certificate lasts: it expires at the end of the 60th month after the month of your examination if you were under 40 on the day of the exam, and at the end of the 24th month if you were 40 or over. Your age on the day of the exam is what counts — turning 40 the following week does not shorten the certificate you already hold.

What actually happens at the exam

Before the appointment you complete FAA Form 8500-8 online through FAA MedXPress, which gives you a confirmation number to take to the examiner. Submit it within sixty days of the exam or the application is deleted and you start again. You find an examiner through the FAA’s designee locator, and any flight school will know who is nearby.

The exam itself takes twenty to thirty minutes: medical history and medications, height and weight, blood pressure and pulse, a hearing check that is usually a conversational-voice test rather than a booth, an eye test, a general physical, and a urine sample — which screens for sugar and protein, and is not a drug test.

If nothing needs a second look, the examiner issues the certificate there and then and you leave holding it. If something does, the examiner defers the application to the FAA, and that is where the timeline becomes weeks or months rather than minutes.

The vision standard people worry about most

14 CFR 67.303 sets the third-class eye standards, and they are gentler than most people assume. Distant vision must be 20/40 or better in each eye separately, with or without corrective lenses. Near vision must be 20/40 at sixteen inches, again each eye, again correction allowed.

So glasses and contact lenses are entirely normal. What you get is a limitation printed on the certificate saying you must wear corrective lenses when you fly, which is a sentence, not an obstacle.

Colour vision is a separate standard: the ability to perceive those colours necessary for the safe performance of airman duties. Not passing the plate test in the office is not the end of it — there are further tests, and the usual outcome for people who pass none of them is a restriction, commonly no night flying and no colour signal control, rather than a refusal.

What actually disqualifies people

Part 67 names a short and specific list. Everything else is a judgement made under a catch-all clause about any condition that would make you unable to fly safely. The named conditions for a third-class certificate are:

• Mental (14 CFR 67.307): psychosis, bipolar disorder, substance dependence, substance abuse within the preceding two years, and a personality disorder severe enough to have repeatedly manifested itself in overt acts.
• Neurological (14 CFR 67.309): epilepsy, a disturbance of consciousness without a satisfactory medical explanation, and a transient loss of control of nervous system function without a satisfactory medical explanation.
• Cardiovascular (14 CFR 67.311): myocardial infarction, angina pectoris, coronary heart disease that has required treatment or has been symptomatic, cardiac valve replacement, a permanent pacemaker, and heart replacement.
• General (14 CFR 67.313): diabetes mellitus requiring insulin or another hypoglycaemic drug for control.

That is the whole named list — fifteen items. Notice what is not on it: asthma, most controlled high blood pressure, corrected vision, a healed injury, anxiety treated years ago and resolved. Those are questions the examiner works through, not automatic refusals.

Why most of that list is a delay rather than a wall

14 CFR 67.401 lets the Federal Air Surgeon issue a medical certificate to somebody who does not meet the standard, on a discretionary basis, once the FAA is satisfied the condition is stable and managed. It is called a special issuance, and it comes with an Authorization letter that lists exactly what your treating doctors have to send in.

There are also mechanisms designed to keep you out of the slow lane afterwards. Under AME-assisted special issuance, your own examiner can re-issue the certificate at renewal if you bring the documents, instead of the file going back to Washington every time. And there is a list of specific conditions an examiner is authorised to issue for in the office at the first visit.

People fly with pacemakers, with treated coronary disease and with well-controlled diabetes. What it costs is time and paperwork, and the paperwork comes from your own doctors — so start collecting records before you apply, not after somebody asks.

The one mistake that is genuinely expensive

If you have a history that might be complicated, talk to an aviation medical examiner before you submit the application. Many will do a consultation precisely for this, and there are aeromedical consultancies that do nothing else.

The reason this matters more than it sounds: a denied, suspended or revoked medical certificate closes off the alternative routes. The FAA is explicit that a pilot whose most recent FAA medical was denied, suspended or revoked may not use a driver’s licence to self-certify for sport pilot privileges. So the fallback that would have kept you flying is exactly the thing a rushed application takes away from you.

Submitting the form is easy and undoing it is not. That asymmetry is the whole argument for making one phone call first.

What if a third-class medical is genuinely out of reach?

There are two other routes, and it is worth knowing which one is available to a beginner, because they are frequently confused.

Sport pilot is the one open to somebody starting from nothing. Under 14 CFR 61.23(c)(1) you may exercise sport pilot privileges holding a valid US driver’s licence instead of a medical certificate, provided you have never had a medical denied, suspended or revoked. The MOSAIC rule that took effect for sport pilots on 22 October 2025 substantially widened the aircraft this covers — heavier, faster, up to four seats — so it is a far more useful certificate than it was two years ago.

BasicMed is not a starting point. 14 CFR 61.23(c)(3) requires that you have held an FAA medical certificate at some point after 14 July 2006, so a brand-new student cannot begin there. Once you have held one, BasicMed keeps you flying on a physician’s examination every 48 calendar months plus an online course every 24, in aircraft up to 12,500 pounds and seven occupants, below 18,000 feet and 250 knots (14 CFR 61.113(i)).

Two things worth sorting out before you apply

Antidepressants and ADHD medication are the two most common reasons an application that looked routine becomes a long one. Approved pathways exist for both — pilots fly on both — but both need records, letters and sometimes testing assembled in advance. Having that conversation with an examiner before you file costs you weeks. Having it after a deferral costs you months.

And answer the questions accurately. The history section is not optional, the FAA does cross-check against other federal records, and an inaccurate answer is a far more serious problem than almost any condition you might be tempted to leave off it.