International flight privileges under new rules
One piece of info that you guys should be aware of, which I haven't seen discussed here, is how going with the new medical option will affect your ability to fly outside the US. The issue is that since ICAO has not changed it's medical standards, the new US standard will not be recognized outside of your borders by any ICAO signatory country, i.e Canada, Mexico, the Bahamas, etc etc etc unless they adopt similar rules internally. More specifically, there are currently no plans to change from the ICAO standard in Canada in the foreseeable future despite our habit of following major changes initiated in the US. There seems to be no appetite for this fight on the part of COPA or any other Canadian advocacy group at this time, and Transport Canada has made it clear they will not initiate this change on their own. They have also issued a statement making it clear that American pilots who do not have medical certification that conforms to an ICAO standard will not be legal to fly in Canada. Period. Your rights and privileges as a Private Pilot will terminate at the border in all directions. It will be exactly the same situation as faced by Sport Pilot permit holders in the US, or Recreational Pilot Permit holders in Canada; no rights outside the borders of your own country.
Apparently a motion to adopt changes to the ICAO standards was introduced at their recent meeting, but support was very lukewarm, and any changes, if they come at all, could take years.
Personally, I think this sucks, and I was quite choked when I read that COPA went so far as to abstain from voting on the ICAO rule changes. I am very puzzled as to why they do not feel any need to pursue these changes in Canada, or internationally, but their stance is a pretty good indication that it may be an uphill battle to see changes at the ICAO level any time in the near future, if ever. So...if you have plans to fly outside the USA for the foreseeable future, keep reporting to your AME for your medicals just like you do now.
*Edit: I see this was briefly addressed a few pages back, my apologies for not reading the whole thread before commenting. Hopefully this post adds some useful information to the discussion.