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HomeHealth ConditionsCOVID-19

At-Home COVID-19 Test Accuracy: What You Should Know

Kerry R. McGee, MD, FAAPAngela Dunn, MD, MPH
Updated on August 30, 2023

Key takeaways:

  • You can buy COVID-19 tests over the counter in many retail shops, including most pharmacies and online.

  • Most at-home COVID tests are rapid antigen tests. These are quick and convenient, but they aren’t the most accurate COVID tests available.

  • The cost of at-home COVID tests varies. The federal government is no longer distributing free tests, but Medicare, Medicaid, and most private health insurance plans cover them.

Close-up of happy woman holding negative COVID-19 result strip
VioletaStoimenova/E+ via Getty Images

Testing for COVID-19 got off to a slow start at the beginning of the coronavirus pandemic. The disease spread quickly — in part because many people didn’t know they were contagious. 

Now, COVID tests are readily available. It only takes a few minutes to find out if you have COVID and if you could spread the virus. And most people can complete a test without leaving home. This makes a big difference when it comes to keeping the virus from spreading through communities.

Here we’ll answer some common questions about at-home COVID tests, including how they work, who should use them, and when.

What is an at-home COVID-19 test?

COVID tests are designed to detect an infection in your body caused by the virus SARS-CoV-2, the culprit behind COVID. If the test detects this virus, the test will be positive (+). If it doesn’t, the test will be negative (-).

At-home COVID test kits contain all the materials and instructions you need to test yourself — or someone else — for COVID. The kits typically include:

  • Instructions

  • A swab to collect material from inside your nose

  • A vial or card to run the test in

  • Chemicals to run the test

The kits are available over the counter (OTC) in many pharmacies and online. Each test can be used only once. 

How do at-home COVID-19 tests work?

For the most part, at-home COVID tests are rapid antigen (Ag or RAT) tests. Rapid antigen tests use microscopic tags that recognize viral particles, or antigens, in the mucus from your nose. When you use the test correctly, viral antigens the swab picks up cause an indicator area on a test strip or card to change color.

Rapid antigen tests are useful because they work quickly and don’t require much equipment. Typically results take 10 to 15 minutes. 

The downside of antigen testing is that these tests aren’t very sensitive. That means that even if the test is negative, you could still have the virus that causes COVID-19. There needs to be a pretty heavy load of virus in your nose for the test to turn positive. If only a small amount of virus is present, the test may not pick it up and result in a negative result.

Keep in mind that at-home COVID tests look for signs of the virus itself. The test is only looking to see if you currently have the virus. They can’t detect antibodies or other signs of immunity in your body.  

How accurate are at-home COVID-19 tests?

At-home COVID antigen tests are pretty good at detecting the virus that causes COVID while you’re experiencing symptoms. They’re not as good at detecting low levels of the virus, which can happen during the first few days of an infection or after you start to feel better. And they may even be less accurate with newer variants of the virus.  

This means a positive result on an at-home antigen test is a strong sign that you have COVID. 

But a negative result needs careful consideration. You might have a negative antigen test but actually have a COVID infection. This can happen if:

  • You tested too early (fewer than 5 days after an exposure).

  • You have a very mild case, or you’re starting to get better.

  • You didn’t get a very good swab from inside your nose.

  • You didn’t use the test correctly, or the test was damaged or expired.

  • You have a variant of the virus that the test doesn’t detect very well.

If you think you have COVID but your at-home COVID antigen test is negative, repeat the test in 48 hours. In the meantime, take steps to avoid possibly spreading it — isolate yourself and assume you’re contagious with COVID.

And, if your at-home COVID test results don’t seem to make sense, talk with a healthcare provider. Other more accurate ways of testing for COVID are available in a medical setting. 

How accurate is a PCR COVID-19 test?

The most accurate COVID test is a PCR test (sometimes called a molecular test, nucleic acid amplification test, or NAAT test). These tests are usually sent to a laboratory and take a couple of days to come back. Typically you get PCR tests from your healthcare provider. But there are some at-home PCR tests, too. 

PCR tests rapidly make thousands of copies of a virus’s DNA found in a sample from your nose. So they can detect the virus even at very low levels. This makes PCR testing more sensitive than antigen testing. And that means you can be more confident that you’re not infected if the result comes back negative.

At the beginning of the pandemic, at-home PCR tests had you collect a swab of material from your nose and send it by mail to a lab (in a sealed tube or bag). The lab tests the material, and you get your results by phone or online. Although these are less common than at-home antigen tests, mail-back PCR tests are still available. 

There are now three FDA-approved at-home COVID test kits designed to bring PCR-like technology into the home: Lucira Check It At Home Test, Cue COVID-19 Test, and Metrix by Aptitude. These tests are more expensive than other types of test kits, but they can be useful. They combine the accuracy of PCR testing with the convenience of an at-home antigen test.

When should you use an at-home COVID-19 test?

Test yourself for COVID right away if you have symptoms, such as:

  • Fever or chills

  • Cough

  • Shortness of breath or difficulty breathing

  • Fatigue

  • Muscle or body aches

  • Headache

  • New loss of taste or smell

  • Sore throat

  • Congestion or runny

  • Nausea or vomiting

  • Diarrhea

You should also test if you think you were exposed to COVID, even if you don’t have symptoms. But you’ll want to wait 5 days before you test.

Sometimes proof of a negative COVID test is needed for travel or to participate in events. If that’s the case for you, check with your travel company or the organizers of your event to make sure an at-home test is an acceptable option. If it is, ask how you should document the results.

Anyone with COVID infection — whether or not they have symptoms — can help protect their community by isolating themselves while they’re contagious.

Where to buy at-home COVID tests?

Although free at-home COVID tests aren’t as readily available as before, you can still find them in your community. Here are some places to try:

  • Pharmacies

  • Retail stores

  • Online

To make sure you’re getting the best test for you, check out the list of FDA-approved at-home COVID tests before buying one.

If you’re looking for low- or no-cost testing:

Does insurance cover at-home coronavirus testing?

The federal government is no longer distributing free tests. But Medicare, Medicaid, and most private health insurance plans cover them.

Insurance companies are required to cover the cost of up to eight OTC, FDA-authorized, at-home COVID tests per person, per month. If your insurance company doesn’t cover the cost of the test up front, save your receipt. In some cases, you may need to submit your receipt to your insurance company for reimbursement. 

Are at-home COVID tests FDA approved?

The FDA has approved a long list of at-home COVID tests. Most of these are OTC antigen tests, but the number of at-home PCR (molecular) tests is growing. 

Will vaccination status affect an at-home COVID test?

No. Getting a COVID vaccine will not affect any at-home COVID antigen or PCR tests. But it’s a different story for some lab or hospital-based tests that look for antibodies in a blood sample. 

Can you use an at-home COVID test if you recently had COVID?

Your at-home COVID test might show up as positive if you recently had COVID. That’s because viral particles can continue to circulate in your body after you’ve recovered. 

Very sensitive tests, such as PCR tests, can continue to show a positive result for up to 90 days after a COVID infection. Antigen tests can continue to show a positive result for up to 30 days. 

If you recover from COVID and your symptoms come back within 90 days, don’t use a PCR test to see if you’re contagious again. Instead, choose an antigen test. If the result is negative, repeat it 48 hours later so you can trust the result.

The bottom line

COVID-19 testing is an important part of protecting yourself and others from illness. These days, at-home tests — especially rapid antigen tests — are easy to get. Testing yourself right away when you have symptoms of COVID is a good idea. If you think you might have been exposed to COVID, but you don’t have symptoms, the best thing to do is to wait 5 days before taking a test.

References

Buchanan, L., et al. (2020). U.S. lags in coronavirus testing after slow response to outbreak. The New York Times. 

Centers for Disease Control and Prevention. (n.d.). No-cost COVID-19 testing

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Centers for Disease Control and Prevention. (2022). Symptoms of COVID-19

Centers for Disease Control and Prevention. (2023). COVID-19 testing: What you need to know

Centers for Disease Control and Prevention. (2023). Self-testing at home or anywhere

CNBC. (2022). Here’s how to get free at-home Covid tests after the federal government program ends

Covid.gov. (n.d.). COVID-19 tests. U.S. Department of Health and Human Services. 

Dinnes, J., et al. (2022). How accurate are rapid antigen tests for diagnosing COVID-19? Cochrane

Kim, J., et al. (2022). Clinical performance of rapid and point-of-care antigen tests for SARS-CoV-2 variants of concern: A living systematic review and meta-analysis. Viruses

National Association of County and City Health Officials. (n.d.). Directory of local health departments

Rao, A., et al. (2023). Sensitivity of rapid antigen tests against SARS-CoV-2 omicron and delta variants. medRxiv

U.S. Department of Health and Human Services. (2022). Biden-Harris administration requires insurance companies and group health plans to cover the cost of at-home COVID-19 tests, increasing access to free tests

U.S. Food and Drug Administration. (2023). At-home OTC COVID-19 diagnostic tests.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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