To fly as a pilot in the United States, you need an FAA medical certificate proving you meet specific standards for vision, hearing, cardiovascular health, and mental health. The exact requirements depend on what type of flying you plan to do, with airline pilots held to stricter standards than private pilots. Here’s what you need to know before you schedule your exam.
Three Classes of Medical Certificates
The FAA issues three classes of medical certificates, each tied to a level of flying privilege. You need the class that matches the highest certificate you plan to use:
- First-Class: Required for airline transport pilots. This is the strictest standard.
- Second-Class: Required for commercial pilots, flight engineers, and air traffic control tower operators.
- Third-Class: Required for private and recreational pilots.
A pilot who holds an airline transport certificate but only has a valid third-class medical can fly only as a private pilot. You always need the medical class that matches the privileges you’re actually exercising.
Vision Standards
Vision requirements are where the three classes diverge most clearly. For distant vision, first- and second-class certificates require 20/20 or better in each eye separately. Third-class certificates are more forgiving at 20/40 or better per eye. In all cases, corrective lenses count. You don’t need perfect uncorrected vision; you just need to reach the standard with or without glasses or contacts.
Near vision is the same across all three classes: 20/40 or better in each eye, measured at 16 inches. First- and second-class applicants aged 50 and older also face an intermediate vision test, requiring 20/40 at 32 inches.
Color vision is required at every level. You need to demonstrate the ability to perceive the colors necessary for safe flight, things like runway lights and chart symbols. As of January 2025, the FAA requires an approved computer-based color vision test administered in person. Three tests are currently accepted: the Colour Assessment and Diagnosis (CAD) test, the Rabin Cone Test, and the Waggoner Computerized Color Vision Test, each with its own scoring thresholds. Printed or downloaded test versions are not allowed.
Hearing Requirements
The baseline hearing test is straightforward. You stand 6 feet from the examiner in a quiet room, back turned, and demonstrate you can hear an average conversational voice using both ears. If you pass, that’s the end of it.
If you fail the conversational voice test, the examiner moves to a pure tone audiometric test. This measures your hearing at specific frequencies. Your better ear can’t exceed 35 decibels of loss at 500 Hz, 30 dB at 1,000 and 2,000 Hz, and 40 dB at 3,000 Hz. Your poorer ear gets more leeway, with thresholds of 35, 50, 50, and 60 dB at those same frequencies.
If you can’t pass either of those, there’s a third option: an audiometric speech discrimination test. You need a score of at least 70 percent in one ear at a moderate volume level.
Blood Pressure and Heart Health
Your blood pressure must not exceed 155/95 mmHg. If you’re within that range, haven’t used blood pressure medication in the past 30 days, and are otherwise healthy, the examiner can issue your certificate on the spot.
If you do take medication for high blood pressure, certification is still possible, but the FAA restricts which medications are acceptable and requires your condition to be well controlled. Any medication adjustment triggers a 7-day grounding period to confirm no side effects. If your hypertension hasn’t been properly evaluated, your medication isn’t on the approved list, or your blood pressure remains uncontrolled, the examiner must defer your application to the FAA for further review.
Mental Health and Antidepressants
A history of mental health treatment does not automatically disqualify you, but the FAA evaluates these cases individually. Pilots taking certain SSRI antidepressants can be considered for certification through a Special Issuance process. To qualify, you must have a diagnosis of mild to moderate depression (single or recurrent episodes), dysthymic disorder, or adjustment disorder with depressed mood. The SSRI can also be used for a non-depression condition.
The key requirement is stability. You need at least 3 continuous months on a stable dose of your medication with no significant side effects and no worsening symptoms before the FAA will consider your case. The examining physician cannot issue the certificate directly; it goes to the FAA for an authorization decision.
Certain conditions are firm disqualifiers in this process: any history of psychosis, suicidal ideation, electroconvulsive therapy, or treatment with multiple psychiatric medications simultaneously.
Diabetes and Insulin Use
Pilots with diabetes can fly, even those on insulin. The FAA requires that you’ve been clinically stable on your current treatment for at least 6 months before applying. First- and second-class applicants who use insulin must submit continuous glucose monitoring (CGM) data as part of their certification package. Third-class applicants have the option of using the CGM protocol or a non-CGM alternative.
The Special Issuance Process
If you don’t meet the standard medical requirements due to a specific condition, you’re not necessarily grounded. The FAA’s Federal Air Surgeon can grant a Special Issuance medical certificate with a set validity period. To get one, you must demonstrate that you can safely perform pilot duties despite your condition, for the entire duration of the certificate.
This can involve additional medical evaluations, practical flight tests, or specialized assessments. Special Issuance certificates expire on a set date and must be renewed by going through the process again. It adds paperwork and time, but it keeps the door open for pilots with conditions like controlled heart disease, treated depression, insulin-dependent diabetes, and many other diagnoses that would otherwise be disqualifying.
How the Exam Works
Your first step is creating an account on FAA MedXPress, a web application where you fill out the medical history portion of your application (FAA Form 8500-8) before your appointment. You only need a valid email address to set up an account. Completing this online saves time during your office visit.
You then schedule an in-person exam with an Aviation Medical Examiner (AME), a physician the FAA has designated to conduct these evaluations. The AME performs the physical exam covering vision, hearing, blood pressure, heart and lung function, neurological checks, and a review of your medical history. For straightforward cases where you meet all the standards, the AME can issue your certificate that day. For anything that requires further review, the AME defers the decision to the FAA.
How Long Certificates Last
Medical certificates don’t last forever, and renewal frequency depends on both the class and your age. Age 40 is the dividing line for most categories.
A first-class certificate lasts 12 months if you’re under 40, but only 6 months if you’re 40 or older. That same first-class certificate continues to function as a second-class for 12 months total, and as a third-class for up to 60 months (under 40) or 24 months (40 and over).
A second-class certificate is valid for 12 months for commercial operations regardless of age. It then downgrades to third-class privileges for the same age-dependent periods: 60 months under 40, 24 months at 40 and over.
A standalone third-class certificate lasts 60 months if you’re under 40 and 24 months if you’re 40 or older. All validity periods are measured from the end of the month in which the exam took place, so an exam on March 3 is treated the same as one on March 28.