The FAA issues 3 classes of medical certificate, and each one unlocks different privileges. To exercise airline transport pilot (ATP) pilot-in-command privileges, you need a first-class medical. If an airline flight deck is your goal, aim for first class from day one.
Timing matters too. You need a medical before you fly solo, and the FAA goes further: “We suggest you get your medical certificate before beginning flight training.” That exam flags any disqualifying condition before you pay for lessons.
Treat the medical as your first checkpoint. Clear it early, and your training becomes a career, not a gamble. Below, you'll learn what each class covers, the standards behind it, and how long it lasts at your age. You'll also see how disqualifiers and Special Issuance work, what changed between 2024 and 2026, and what airline pipeline programs expect.
What Each FAA Medical Class Covers
Each class matches a level of privilege. First class covers airline captain duties. Second class covers commercial flying, and third class covers student and private flying.
These rules come from 14 CFR 61.23 and Part 67, as published on eCFR (current Oct 2026).
First, Second, and Third Class at a Glance
| Class | Required for | Distant vision | ECG | Typical career stage |
|---|---|---|---|---|
| First | ATP pilot-in-command (PIC) privileges; any required Part 121 pilot age 60+ | 20/20 each eye, with or without correction | First application after age 35, then annually after 40 | Airline captain; pipeline program entry |
| Second | Commercial pilot privileges; most Part 121 second-in-command (SIC) seats | 20/20 each eye, with or without correction | Not routinely required | Commercial pilot, CFI building hours, first officer |
| Third | Student and private pilot privileges | 20/40 each eye, with or without correction | Not routinely required | Student pilot through private pilot |
First class also applies to SIC seats in Part 121 flag or supplemental operations that need 3 or more pilots. A first-class medical carries second- and third-class privileges as it ages out. The validity table below shows exactly when.
A common error lists 20/40 vision for second class. The regulation (14 CFR 67.203) sets 20/20 distant, the same as first class.
Vision, Hearing, and Heart Standards
An Aviation Medical Examiner (AME) is a physician the FAA designates to perform your exam. Your AME checks each of these standards:
- Distant vision: Glasses and contacts are allowed. If you need them, “must wear corrective lenses” becomes a limitation on your certificate.
- Near vision: You need 20/40 at 16 inches. At age 50 and older, first and second class add a 32-inch check.
- Color vision: You must perceive the colors needed to perform airman duties safely. Since Jan 1, 2025, screening uses computer-based tests only, taken in person.
- Hearing: You must hear a conversational voice at 6 feet with your back turned. An audiometric test is an accepted alternative.
- Blood pressure: The FAA's guideline maximum is 155/95. Part 67 itself sets no number.
- Heart: Only first class requires an electrocardiogram (ECG), on the schedule in the table above.
How Long Each Medical Is Valid
Your validity depends on 2 things: the privilege you use and your age on the exam date. Each period ends on the last day of the final calendar month. A 12-month medical from a March 2026 exam runs through March 31, 2027.
| Privilege you're using | Under 40 at exam | 40 or older at exam |
|---|---|---|
| ATP pilot-in-command (first class) | 12 months | 6 months |
| Commercial pilot (first or second class) | 12 months | 12 months |
| Student, private, or CFI acting as PIC (any class) | 60 months | 24 months |
A CFI who isn't acting as PIC or serving as required crew needs no medical under 14 CFR 61.23(b)(7).
For career changers: Age 40 changes your clock. Say you're 42 and earn a first-class medical. You hold ATP privileges for 6 months, commercial for 12, and private for 24. Build each renewal into your training flight plan so a lapsed medical never grounds you mid-program.
Disqualifiers, Special Issuance, and What Changed in 2024–2026
A listed condition triggers FAA review. The FAA then decides your case on your own medical record.
Conditions That Need FAA Review
The FAA lists 15 conditions that examiners must deny or defer unless the FAA directs otherwise. They include diabetes requiring hypoglycemic medication, coronary heart disease, myocardial infarction, psychosis, bipolar disorder, epilepsy, and substance dependence or abuse.
A deferral sends your case to the FAA. Under 14 CFR 67.401, the Federal Air Surgeon may grant a Special Issuance at their discretion. A Statement of Demonstrated Ability (SODA) covers static, non-progressive conditions and does not expire.
Neither outcome is promised. Individual outcomes depend on FAA review. Your part is clear: disclose honestly and bring your records. If you have a health history question, talk to an AME before your exam. AOPA's medical resources can also help you prepare.
Recent FAA Policy Updates
FAA guidance to AMEs has shifted in several areas since 2024:
| Date | Change |
|---|---|
| Jun 2024 | AMEs may issue certificates for an uncomplicated anxiety or depression history under defined conditions, without FAA review. |
| Jan 1, 2025 | Color vision screening moves to computer-based tests only, taken in person. |
| Dec 3, 2025 | The antidepressant stable-dose period shortens to 3 months (previously 6). |
| May 2026 | The FAA adds an information page on therapy, psychotherapy, and counseling for pilots. |
These changes update guidance to examiners. Individual cases still require review, and bipolar disorder, psychosis, and the other listed conditions remain on the deny-or-defer list.
What Airline Pipeline Programs Expect
Airline pipeline programs set their bar at or near first class. Here's what each program page stated as of Nov 2026:
- United Aviate: You need a valid FAA medical originally issued as first or second class.
- United Aviate Academy: You need a first-class medical with first-class privileges throughout training. The only accepted restriction is “must wear corrective lenses.”
- Southwest Destination 225°: The cadet pathway asks that you be able to obtain an FAA first-class medical. Applications were closed at the time of review.
A third-class medical covers student flying. Get your first-class medical early anyway, so you know you meet your target program's standard before you invest. You train the way you'll work, and the airline standard starts with the medical.
For military veterans: An up-to-date military flight physical covers only domestic flights that need no more than a third-class medical. Plan on a civilian FAA medical for career training.
For international students: The same FAA medical standards apply when you train in the US.
US Aviation Academy trains on a Part 141 FAA-approved curriculum built around airline pathways, including United Aviate and Southwest Destination 225°. One note on BasicMed: it doesn't allow flying for compensation or hire, so it is not a career option.
Practical Takeaways
- Get first class first: Book your exam with an AME designated for first class. Do it before you commit to training.
- Apply online first: Complete the FAA MedXPress online application before your appointment. It shortens your office visit with the AME. Bring government-issued photo ID.
- Know your clock: Your age at the exam, under 40 or 40 and older, sets your validity. Put your renewal date on your calendar.
- Bring your records: If you have a health history, bring documentation. Ask the AME your questions before the exam.
- Glasses are fine: Correctable vision meets the standard. Your certificate notes that you must wear corrective lenses.
- Ask about fees: Ask the AME's office about the exam fee when you book.
Conclusion
Your medical is the first gate on a defined path to the airline flight deck. Clear it early, and you'll train knowing you meet the standard your career requires. That's how you make it a career, not a gamble.
Most people who meet the standard just need to show up prepared. You don't need a runway behind you. Just the willingness to meet the standard.
Book your first-class exam, then see what airline-standard training feels like. Schedule a Discovery Flight