Going from third class medical to BasicMed. any pitfalls I should be aware of?

[francisco collazos]

So i've had controlled hypertension for about 20+years and early this year after my visit with the AME, my BP went up. So over the last couple of weeks we have been working on the right medication combination and it's now controlled. My Dr. recommended a cardiologist visit due to my age and I have one set for the beginning of the year. This got me thinking about keeping my 3rd class and how easy it would be for me to lose it. I just got it reapproved this year for another 2 yrs but I am thinking that i'm better off going to BasicMed. So if there is no issue with the cardiologist I should be able to apply but if they find something I would need to report it to the FAA is this correct?

 

[dbahn]

You would need to self-ground if the cardiologist found an issue that would make "the person unable to meet the requirements for the medical certificate necessary for the pilot operation", but you DO NOT need to and definitely should not report that to the FAA until your next medical is due. You are still eligible for Basic Med as long as you don't report it on an FAA medical application, in which case you need to comply with the other conditions in 61.53 which says "make the person unable to operate the aircraft in a safe manner", which is an entirely different standard, and it doesn't involve the FAA process.

My suggestion to anyone in your situation is to go ahead and apply for Basic Med even though you're medically qualified with the FAA process now. If something comes up between now and when your next medical is due, it's up to you and your doctor to determine if you meet the requirement for operating safely, and there's a lot of leeway in that determination. Having it along with your FAA medical certificate gives you a lot of leeway to (1) better manage your own health without the FAA's oversight and (2) allowing you considerable time to continue flying while you sort out your risks on another future MedExpress.

 

[francisco collazos]

Thank you so much!!! that is exactly the information I was looking for

 

[Punkinhead]

One thing to make sure of is that your aviation insurance covers you under BasicMed. During my last renewal my agent got quotes from two companies but one would not cover pilots flying under BasicMed or Light Sport.

 

[francisco collazos]

One thing to make sure of is that your aviation insurance covers you under BasicMed. During my last renewal my agent got quotes from two companies but one would not cover pilots flying under BasicMed or Light Sport.

Thank you for the additional comment. Right now I am renting so I have rental insurance but I will look into this if I ever buy a plane.

 

[Tokirbymd]

One thing to make sure of is that your aviation insurance covers you under BasicMed. During my last renewal my agent got quotes from two companies but one would not cover pilots flying under BasicMed or Light Sport.

was that an age related thing? I've heard of that for "older" pilots but never as an across the board policy.

 

[dbahn]

One thing to make sure of is that your aviation insurance covers you under BasicMed. During my last renewal my agent got quotes from two companies but one would not cover pilots flying under BasicMed or Light Sport.

You can do both until the current medical expires. The only downside is that you may (or may not, if your own doc will do it for free) pay for a visit to a physician willing to fill our the paperwork. And if the physician doesn't feel comfortable with that, you can still look for another one without the FAA being involved. In two years if insurers won't cover Basic Med then your only option is to go through an AME, with all of the risks associated with that.

 

[Half Fast]

You would need to self-ground if the cardiologist found an issue that would make "the person unable to meet the requirements for the medical certificate necessary for the pilot operation",....

Don’t forget the cardio conditions that would require an SI 3rd class prior to Basic Med:

• A cardiovascular condition, limited to a one-time special issuance for each diagnosis of the following:
  • Myocardial infarction;
  • Coronary heart disease that has required treatment;
  • Cardiac valve replacement; or
  • Heart replacement.

 

[dbahn]

Don’t forget the cardio conditions that would require an SI 3rd class prior to Basic Med:

• A cardiovascular condition, limited to a one-time special issuance for each diagnosis of the following:
  • Myocardial infarction;
  • Coronary heart disease that has required treatment;
  • Cardiac valve replacement; or
  • Heart replacement.

Yes, those would be a factor either way, but Basic Med still has some leeway in what "required treatment" means vs. the FAA which will focus on the testing and possibly other factors they see in the medical record. For instance most docs won't consider exercise, diet, weight loss and other management strategies as "treatment", where the FAA would be looking over that same medical record to pick up anything that might need further documentation. With a 20 year history of hypertension, there are bound to be some "abnormal" findings on a full cardiac workup, any one of which can generate the need for further testing.

Further testing = further risk of denial (and/or long and often expensive delay in resolution). But your point is very important.

The OP's concern was a longstanding diagnosis of hypertension, not cardiac disease. If the FAA reviewed that medical record and saw a recommendation for an echocardiogram, they may very well have asked for the results of the echo or for other tests to rule out significant cardiac disease.

 

[Half Fast]

With a 20 year history of hypertension, there are bound to be some "abnormal" findings on a full cardiac workup,

Not necessarily. There weren’t any on mine, and I’ve been on BP meds for many years. After reviewing the results of my nuclear stress test, the cardiologist said my heart was good for at least another 30 years (I was 58 at the time).

If the FAA reviewed that medical record and saw a recommendation for an echocardiogram,...

One of the (many) nice things about Basic Med is that the FAA doesn’t get that shot unless you give it to them. If you do develop one of the conditions that would require a new 3rd class SI, you can decide not to pursue it and switch to LSAs.

 

[Punkinhead]

was that an age related thing? I've heard of that for "older" pilots but never as an across the board policy.

I was 56 at the time so I don't think it was age related. But I'm not trying to sound alarmist. I switched to BasicMed as soon as it was available and I've never had trouble getting insurance. You just want to make sure the particular insurer you choose doesn't have that limitation.

 

[midlifeflyer]

One thing to make sure of is that your aviation insurance covers you under BasicMed. During my last renewal my agent got quotes from two companies but one would not cover pilots flying under BasicMed or Light Sport.

Good reason to look around. I’ve not see that in years, not since there were underwriting stats that there was no difference in exposure. But i guess there is still some of that around.

The exception is age. I can see an underwriter still wanting a third class evaluation. But I’ve also seen BasicMed acceptance, sometimes with a requirement to update the medical exam every year, a type of requirement that’s not particularly unusual.

 

[OneCharlieTango]

So if there is no issue with the cardiologist I should be able to apply but if they find something I would need to report it to the FAA is this correct?

I want to make sure this is clear: unless the cardiologist finds something from the list in Reply #8, you don’t have to talk to the FAA about it. And the Subject line here asks about pitfalls to BasicMed. There are none. Absolutely none. There are limitations, which Google will readily reveal. The only one that’s relevant to me is the inability to use it in Canada.

If you get an annual doctor visit, email ahead about BasicMed. If you don’t, the fact that it gets you to see a doctor is just one more good thing BasicMed gives us.

One thing to make sure of is that your aviation insurance covers you under BasicMed. During my last renewal my agent got quotes from two companies but one would not cover pilots flying under BasicMed or Light Sport.

Which company was that?

 

[Punkinhead]

Which company was that?

Old Republic Aerospace

 

[dbahn]

Not necessarily. There weren’t any on mine, and I’ve been on BP meds for many years. After reviewing the results of my nuclear stress test, the cardiologist said my heart was good for at least another 30 years (I was 58 at the time).

That's the purpose of the meds. If your blood pressure is well controlled for that period then the cardiac changes are less likely.

I don't recall for certain, but I think when I started to fly hypertension was disqualifying and anti-hypertensive meds weren't permitted. But the FAA threshold for disqualification is still high (155/95) and some pilots choose to accept pressures just below that to avoid medication, but they are more likely to develop end organ changes in the process. BP "control" can be accomplished by exercise, diet, weight control, etc., but the meds are generally more effective. It wasn't clear what the OP's method of control was for the past 20 years, only that meds were now getting it controlled.

 

[Lon Stratton]

My suggestion to anyone in your situation is to go ahead and apply for Basic Med even though you're medically qualified with the FAA process now. If something comes up between now and when your next medical is due, it's up to you and your doctor to determine if you meet the requirement for operating safely, and there's a lot of leeway in that determination. Having it along with your FAA medical certificate gives you a lot of leeway to (1) better manage your own health without the FAA's oversight and (2) allowing you considerable time to continue flying while you sort out your risks on another future MedExpress.

Exactly what I did. Always got a Second Class, then would let it go to a Third. Was over lapping for almost two years. Checked with my insurance. My agent said I should be good until 80 (69 now). My Primary care doc that I've seen for 34 years had no problem doing Basic Med for me. AOPA recommended I never apply for a medical again. Any denial for any reason would invalidate the BasicMed. I always felt like the aviation medical exam was a joke, so for many years I always asked my PCP to make sure HE thinks I'm fit to fly. If my PCP was an AME I would probably have continued on with the FAA medical because he actually knows me and my health history. My AME really didn't.
So, Basic Med it is until I can't fly anymore.

 

[dbahn]

So, Basic Med it is until I can't fly anymore.

At age 76 now that's my strategy as well, with insurance being the looming determinant.

One uncertainty in my mind is how the data evolves with respect to Basic Med and claims history. As the time period expands since having to hold an FAA issued medical certificate to qualify for Basic Med, applicants just get further away from the rigid requirements imposed by the FAA. That could have an adverse effect if more medically dangerous conditions are allowed, or it could have a positive effect if pilots are successful managing their own health more effectively. Time will tell.

Then we have MOSAIC . . .

 

[Chip Sylverne]

Based on my conversations with some of the United Flying Octogenarians around my patch, the insurance question is not only age, but what you fly. If you fly a tricycle fixed gear less than 200hp, basic med isn't a problem. If you fly high-performance, retract, floats or conventional gear, it gets sticky. Also changing underwriters is frowned upon.

 

[Lon Stratton]

Based on my conversations with some of the United Flying Octogenarians around my patch, the insurance question is not only age, but what you fly. If you fly a tricycle fixed gear less than 200hp, basic med isn't a problem. If you fly high-performance, retract, floats or conventional gear, it gets sticky. Also changing underwriters is frowned upon.

I really hope I have to deal with all that.....

 

[midlifeflyer]

One uncertainty in my mind is how the data evolves with respect to Basic Med and claims history. As the time period expands since having to hold an FAA issued medical certificate to qualify for Basic Med, applicants just get further away from the rigid requirements imposed by the FAA. That could have an adverse effect if more medically dangerous conditions are allowed, or it could have a positive effect if pilots are successful managing their own health more effectively. Time will tell.

That was the big "sky is falling" issue when BasicMed was just an idea. I pooh-poohed it.

According to the most recent FAA study (2021). While it disclaims ultimate generalizations due to the sample sizes (your "time will tell")

The estimated overall accident rate per 100,000 flight hours for the BasicMed group was 7.3 (fatal: 1.6) compared to 7.0 (fatal: 1.4) for the medically certified pilots. The fatal accident rate per 100,000 flight hours was 1.6 for the BasicMed group and 1.4 for the medically certified pilots. The differences in overall and fatal accidents were not statistically significant. No statistically significant differences were found when multiple age subgroups were compared. Also, logistic regression models adjusted for relevant confounders revealed no significantly elevated accident ORs between the BasicMed and third-class certified pilot groups overall.​

— Estimated Accident Risk for BasicMed vs. Medically Certified U.S. Pilots​

And that doesn't account for whether the cause of the accidents was a medical deficiency. On that score, there's the 2022 FAA Safety Briefing, Medical Factors in Aviation Mishaps where Dr Northrup suggests drugs, alcohol, and unreported medical conditions were involved in a statistically significant number of fatal accidents:

Over 40% had incidental medical findings (IMFs), which are medical conditions not previously known by the FAA, but discovered on autopsy. The NTSB determined that for this group of pilots, the most common medical issues, that were either causal or contributory, were use of a sedating medication, followed by alcohol or illicit drug use, cardiovascular disease, neuropsychiatric problems, and strokes.​

I'm really bad at statistical analysis but in my mind, the two puts drugs, alcohol, and flying with a known deficiency, all of which can and do take place with Class 1, 2 and 3 medical certificate holders as well as BasicMed pilots, way ahead of any BasicMed-related issues.

 

[midlifeflyer]

Based on my conversations with some of the United Flying Octogenarians around my patch, the insurance question is not only age, but what you fly. If you fly a tricycle fixed gear less than 200hp, basic med isn't a problem. If you fly high-performance, retract, floats or conventional gear, it gets sticky. Also changing underwriters is frowned upon.

I've seen the frowned upon. If you've been paying premiums for years without claims, it makes sense you are in better shape with that carrier than someone applying for the first time.

 

[dbahn]

That was the big "sky is falling" issue when BasicMed was just an idea. I pooh-poohed it.

According to the most recent FAA study (2021). While it disclaims ultimate generalizations due to the sample sizes (your "time will tell")

The estimated overall accident rate per 100,000 flight hours for the BasicMed group was 7.3 (fatal: 1.6) compared to 7.0 (fatal: 1.4) for the medically certified pilots. The fatal accident rate per 100,000 flight hours was 1.6 for the BasicMed group and 1.4 for the medically certified pilots. The differences in overall and fatal accidents were not statistically significant. No statistically significant differences were found when multiple age subgroups were compared. Also, logistic regression models adjusted for relevant confounders revealed no significantly elevated accident ORs between the BasicMed and third-class certified pilot groups overall.​

— Estimated Accident Risk for BasicMed vs. Medically Certified U.S. Pilots​

And that doesn't account for whether the cause of the accidents was a medical deficiency. On that score, there's the 2022 FAA Safety Briefing, Medical Factors in Aviation Mishaps where Dr Northrup suggests drugs, alcohol, and unreported medical conditions were involved in a statistically significant number of fatal accidents:

Over 40% had incidental medical findings (IMFs), which are medical conditions not previously known by the FAA, but discovered on autopsy. The NTSB determined that for this group of pilots, the most common medical issues, that were either causal or contributory, were use of a sedating medication, followed by alcohol or illicit drug use, cardiovascular disease, neuropsychiatric problems, and strokes.​

I'm really bad at statistical analysis but in my mind, the two puts drugs, alcohol, and flying with a known deficiency, all of which can and do take place with Class 1, 2 and 3 medical certificate holders as well as BasicMed pilots, way ahead of any BasicMed-related issues.

Do those statistics account for a difference in pilot qualifications? It seems logical that medically certified pilots include a larger subset of active commercial pilots, although that doesn't necessarily mean that the commercial pilots are less likely to be involved in accidents. I think there is some data that suggests that the difference isn't significant either, but I don't remember.

 

[midlifeflyer]

Do those statistics account for a difference in pilot qualifications? It seems logical that medically certified pilots include a larger subset of active commercial pilots, although that doesn't necessarily mean that the commercial pilots are less likely to be involved in accidents. I think there is some data that suggests that the difference isn't significant either, but I don't remember.

I didn't delve quite that deeply into it.