The First Class Medical Certificate, Explained Properly

A first class medical certificate is valid for airline transport pilot privileges for 12 calendar months if you were under 40 on the date of the examination, and 6 calendar months if you were 40 or over. Those periods are set by 14 CFR 61.23(d) and they run to the end of the last day of the month. The certificate then continues to serve as a second class and a third class for longer periods, so it does not stop being useful when the ATP period ends.

The three classes match three levels of privilege. A third class medical covers private, recreational, student and flight instructor flying and requires 20/40 distant vision in each eye. A second class medical covers commercial privileges, is valid 12 calendar months for those privileges at any age, and requires 20/20 distant vision. A first class medical covers airline transport pilot privileges, requires 20/20 distant vision, and adds an ECG at 35 and annually from 40.

No. You do not need any medical certificate to begin flight lessons, and you do not need one for a discovery flight. You need a medical before your first solo, which for most students is somewhere between 15 and 25 hours in. If you are training toward an airline career, get the first class rather than the third, because the first class standards are the strictest and passing them settles every class below.

Yes. Under 14 CFR 61.23(d) one certificate carries three expiry dates that run simultaneously from the examination date. A first class issued to a 42-year-old on 12 March 2026 gives ATP privileges through 30 September 2026, commercial privileges through 31 March 2027, and private, student and flight instructor privileges through 31 March 2028. Nothing is reissued; the same piece of paper simply steps down.

14 CFR 67.103 requires distant visual acuity of 20/20 or better in each eye separately, with or without corrective lenses, plus near vision of 20/40 at 16 inches and, from age 50, intermediate vision of 20/40 at 32 inches. It also requires normal fields of vision. The standard is correctable acuity, so glasses and contact lenses are acceptable at every class; the certificate is simply issued with a limitation requiring you to wear them.

Yes, but not at every exam and not at every age. Under 14 CFR 67.111(b) an electrocardiogram is required at the first first-class application after your 35th birthday, and then annually after your 40th birthday. There is no ECG requirement at second or third class. The ECG must be dated no earlier than 60 days before the application.

Yes. Corrective lenses are explicitly permitted by 14 CFR 67.103(a), which asks for 20/20 or better in each eye with or without correction. If you need glasses or contacts to reach 20/20, the first class medical is issued with a limitation stating that corrective lenses must be worn while exercising the privileges of the certificate. Laser vision correction is also routinely accepted after a healing and stability period.

14 CFR 67.111 through 67.113 list conditions including myocardial infarction, angina, coronary heart disease requiring treatment, cardiac valve replacement, a permanent pacemaker, heart replacement, epilepsy, a disturbance of consciousness without satisfactory explanation, psychosis, bipolar disorder and substance dependence. Many of these are still certificated in practice through a Special Issuance under 14 CFR 67.401. Only an AME or the FAA can determine your outcome; no flight school can.

The fee is set by the individual aviation medical examiner, not by the FAA and not by any flight school, so it varies from one office to another and city to city. A first class exam costs more than a third class because it includes additional vision testing and, from age 35, an electrocardiogram. Call two or three examiners from the FAA AME locator and ask before you book.

Complete the FAA MedXPress application online first, then use the FAA AME locator to find an examiner. Check that the examiner is authorized for first class exams, because a Senior AME can issue all three classes while other examiners are designated for second and third class only. Bring photo identification, your glasses or contacts with the prescription, and records for anything you disclosed. Most applicants are issued the same morning.

For most commercial flying, yes. A second class medical certificate covers commercial pilot privileges and is valid 12 calendar months for those privileges regardless of your age, under 14 CFR 61.23(d). You need a first class only to exercise airline transport pilot privileges, which is what airline operations under Part 121 require. Many working pilots hold a first class anyway because it steps down to a second class for the same 12 months.