The USMLE Exam registration process changed significantly in January 2026. If you are an Indian or international medical graduate who started researching this before the transition, a lot of what you read online is already outdated. The old ECFMG MyIntealth portal no longer handles exam registration. There are now two separate systems, and using the wrong one will delay your application by weeks.
This guide explains the new 2026 USMLE registration process for IMGs, what each portal does, the correct order to follow, current fees, documents you need, and the mistakes that trip up most first-time applicants.
What Changed in January 2026
Before 2026, IMGs handled almost everything through ECFMG’s MyIntealth portal. Credential verification, eligibility, and exam registration all lived in one place. That changed with the USMLE Service Transition that launched in two phases in January 2026.
On January 12, 2026, USMLE Step exam services for IMGs transferred from ECFMG to FSMB. This means all USMLE services for all three Step exams are now managed by FSMB for IMGs.
MyIntealth now handles only certification-related services. If you try registering for exams through MyIntealth, you will waste weeks figuring out the error.
For US and Canadian medical students, NBME began managing all USMLE Exam registration services through the MyUSMLE portal from January 26, 2026.
In short: IMGs use FSMB. US and Canadian students use MyUSMLE. These are two separate portals for two separate groups of applicants.
The Two Portals You Need to Know
MyIntealth (ecfmg.org/myintealth) This is still relevant for IMGs, but only for ECFMG certification. MyIntealth is now only for ECFMG eligibility and certification. It is no longer used to register for USMLE Step exams. You must complete your ECFMG eligibility steps here before you can register anywhere else.
FSMB USMLE Portal (usmle.fsmb.org) This is where IMGs now register for Step 1, Step 2 CK, and Step 3. You access your scheduling permit here, manage your eligibility period, and receive your score reports. Since January 12, 2026, all exam registration for IMGs goes through FSMB at usmle.fsmb.org.
MyUSMLE Portal (myusmle.nbme.org) This portal is for US and Canadian students from LCME or COCA accredited schools only. If you are an IMG, this portal is not your registration pathway.
Documents You Need Before You Start
Get these ready before you open any portal. Missing even one will stall your application mid-process.
- Valid passport (used as your primary ID throughout)
- Medical school transcript showing your degree
- ECFMG ID number (obtained after creating your MyIntealth account)
- Recent passport-size photo in digital format
- Credit or debit card for fee payment
Step-by-Step Registration Process for IMGs
The IMG registration pathway runs across two platforms in a fixed sequence. f you attempt to register for Step 1 without completing MyIntealth prerequisites first, your FSMB application will fail automatically. Do not skip ahead.
Step 1: Complete ECFMG Eligibility Through MyIntealth
Go to ecfmg.org and create your MyIntealth account. This is where you submit your medical school credentials, transcripts, and proof of degree for verification. ECFMG reviews these documents and confirms your eligibility.
This step takes time. Build at least 4 to 8 weeks into your timeline for document processing before you plan to register for an exam.
Step 2: Obtain Your ECFMG ID
Once your MyIntealth account is created and your records are active, you will receive your ECFMG identification number. You will need this when you move to the FSMB portal.
Step 3: Create Your FSMB Account
Go to usmle.fsmb.org and create an account using the exact same name and date of birth that appear on your medical credentials. Even minor name inconsistencies between your FSMB account and your documents can cause verification failures.
Step 4: Link Your ECFMG Eligibility
Once your FSMB account is set up, the system will verify your ECFMG eligibility status. FSMB will verify eligibility via ECFMG. You cannot proceed to registration until this verification is confirmed.
Step 5: Fill Out the Application
Select your exam step (Step 1, Step 2 CK, or Step 3), upload your required documents, and choose your eligibility period. Your eligibility period is a 3-month testing window during which you must sit the exam. Choose this window carefully based on your preparation timeline because changing it later involves additional fees and paperwork.
Step 6: Pay the Registration Fee
Pay online through the FSMB portal. All fees are non-refundable.
Step 7: Receive Your Scheduling Permit
Once your application is approved and payment is processed, your scheduling permit will be available in your FSMB account. This permit is what you use to book your actual exam date.
Step 8: Book Your Prometric Date
Use your scheduling permit to book your test date at a Prometric centre. Do this as soon as you receive the permit. Popular test centres, especially in India, fill up weeks in advance during peak periods between June and September.
Step 9: Confirm Everything Before Exam Day
Check that your permit details match your ID exactly. Review your exam centre address, reporting time, and the items you are allowed to bring. Any mismatch between your permit and your ID on exam day can result in being turned away.
Step-by-Step Registration for US and Canadian Students
If you are studying at an LCME or COCA accredited school in the US or Canada, your process is simpler and entirely within one portal.
Go to the MyUSMLE portal at myusmle.nbme.org and create an account. You will receive a unique USMLE ID that follows you across all steps. Complete identity verification through ID.me, upload your documents, select your exam step and eligibility period, pay the fee, and wait for your scheduling permit. Then book your Prometric date the same way as IMGs.
USMLE Registration Fees in 2026
| Exam | US and Canadian Students | IMGs Outside US and Canada |
|---|---|---|
| Step 1 | $695 | $900 ($695 base + $205 international surcharge) |
| Step 2 CK | $695 | $925 ($695 base + $230 international surcharge) |
| Step 3 | $955 | $955 (no international surcharge, only taken in the US) |
All fees are non-refundable. Verify the current amounts at usmle.org before submitting payment as fees are reviewed periodically. Do not rely on INR conversions listed anywhere online since exchange rates change constantly.
When Should You Register?
Start at least 3 to 6 months before your target exam date. This accounts for ECFMG document processing time, FSMB verification, and Prometric seat availability. If you are targeting a June to September exam date, start even earlier as those months are the most competitive for test centre slots in India.
A common mistake is finishing your preparation, then starting the registration process. By the time documents clear and a Prometric date is available, you have lost weeks of momentum. Start registration while you are still preparing, not after.
Common Mistakes to Avoid
Using the wrong portal. IMGs who go to MyUSMLE instead of the FSMB portal will not be able to complete registration. Check your pathway before you create any account.
Skipping ECFMG eligibility before FSMB registration. This is the most common reason IMG applications fail at the FSMB stage. Complete MyIntealth first, every time.
Name mismatches across documents. Use your passport name exactly, including spacing and initials, across every form and account. Small inconsistencies cause verification delays that can set you back by weeks.
Choosing an eligibility period without checking preparation readiness. Your 3-month window is a commitment. If you are not ready to sit the exam within that window, you will need to pay to extend it.
Booking a Prometric date too late. Seats in major Indian cities like Delhi, Mumbai, Bengaluru, and Hyderabad book up fast. Secure your date as soon as your scheduling permit is in hand.
Not budgeting for ECFMG credential verification fees. Many IMGs account for the USMLE step registration fee but forget the separate ECFMG fees for credential verification. Budget for both before you start.
Conclusion
The 2026 USMLE registration process is more organised than the old system, but it requires more careful navigation because two platforms are now involved instead of one. For IMGs, the correct sequence is always MyIntealth first for ECFMG eligibility, then FSMB for exam registration. Do not attempt to reverse this or skip either step.
Register early, use your passport name consistently across every form, book your Prometric date the moment your permit arrives, and give yourself at least 3 to 6 months of lead time before your target exam date.
If you are at the stage of planning your USMLE journey and want a structured study plan built around your timeline, the USMLE Success Strategy consultation with Dr. Apurva Popat covers preparation planning alongside the registration and scheduling decisions that most IMGs get wrong.
