It was established in 1963 by President John F. Kennedy, superseding the Medal of Freedom that was established by President Harry S. Truman in 1945 to honor civilian service during World War II.
The medal is suspended on a blue ribbon, and it incorporates the colour scheme found on the presidential seal. Its most visible design element is a white star, upon which is centred a collection of 13 smaller gold stars arranged on a field of blue. A red pentagon is set behind the white star, and gold eagles bridge the distance between the points of the star. The recipient’s name is engraved on the reverse side of the medal.
A special, rarely given grade of the medal, known as the Presidential Medal of Freedom with Distinction,[7] has a larger execution of the same medal design worn as a star on the left chest along with a sash over the right shoulder (similar to how the insignia of a Grand Cross is worn), with its rosette (blue with white edge, bearing the central disc of the medal at its center) resting on the left hip. When the medal With Distinction is awarded, the star may be presented descending from a neck ribbon and can be identified by its larger size than the standard medal