The 3 best at-home COVID-19 tests for traveling or checking symptoms

Pros: Lets you billing directly to insurance; can use FSA/HSA to purchase; with insurance, repeat testing possible with no cost for you; highly accurate

Cons: Eligibility requirements; more hoops to jump through for future testing; unconfirmed accuracy

LabCorp, the brick-and-mortar lab where your doctor often sends you to run basic blood tests, was one of the first on the scene for at-home COVID testing. The Pixel is a PCR test collected via a nasal swab. The biggest perk of this test is that it is free for everyone: You can directly bill your insurance company or bill it to the federal fund if you're uninsured. Either way, it's $0 to you, including shipping. (Out of pocket it would otherwise run you $119.)

However, it loses points because we couldn't find the NDU/mL measurement to determine the accuracy of this PCR nasal swab. That being said, when we tested it on both a person with COVID and without, it was accurate on both accounts.

Another pain point: You must meet specific requirements to be eligible to order. These can be just exhibiting mild symptoms or having a doctor request, but you also can't have too severe of symptoms. If you have, say, a 102℉ fever, the site will block you from purchasing and direct you to seek your healthcare provider.

In the bigger picture, this is good since it tells you to seek medical attention ASAP. But it can also be frustrating if you're alone and too sick to go wait in line for an in-person PCR test. 

LabCorp uses FedEx and does Saturday delivery which is great. It also provides instructions to schedule a free FedEx pickup. In our experience, the kit arrived within 24 hours of ordering and took 48 hours after FedEx picked it up to provide results.

Pros: No eligibility requirements; lets you bill directly to insurance; can use FSA/HSA to purchase; with insurance, repeat testing possible with no cost for you; highly accurate

Cons: Still have to pay for $20 shipping if insurance covers test

This test ticks a lot of boxes: Tied for top slot on the FDA report with 180 NDU/mL (listed by their lab name, Viracor Eurofins Clinical Diagnostics), EmpowerDX is evidently one of the most accurate PCR tests you can buy. The tests are readily available and you don't need to meet any specific requirements (minimum symptoms, exposure risk) to order one. 

The company's highly-accurate PCR nasal swab test is $99, but if you have insurance coverage, the test can be billed directly. However, you still have to pay $20 for shipping. Nonetheless, the main reason we love EmpowerDX's test is it's a cheap way to get a highly accurate test if you have insurance. Almost every expert source agreed that repeat testing is ideal to control the spread of COVID-19.

That being said, if you are paying out of pocket (OOP), we recommend purchasing this test through Amazon Prime, where shipping is included.

Thad Mick, PharmD, vice president of Pharmacy, Laboratory Services and Imaging Programs at telehealth service ZOOM+Care, who is not affiliated with the company, calls this "a great option" and said, "it is likely one of the more reliable choices alongside Pixel."

Pros: Covered by most insurance; can pay with FSA/HSA card; highly accurate test; medical consultation included; fast shipping included; cheapest to pay OOP

Cons: Requires you to pay OOP and then get reimbursed by insurance; eligibility requirements

This test is the cheapest if you're paying out of pocket. However, if you have insurance, it doesn't let you bill directly — you have to pay out-of-pocket upfront and then invoice your insurance company to be reimbursed. (Although it does allow you to use your FSA/HSA card, which is nice for those who have it). This is a huge barrier for people who don't have a spare $109 to cover the test while they wait for insurance to kick in.

But, as far as we know, this is the most accurate of the OOP-then-reimburse category at 720 NDU/mL sensitivity. 

The higher price tag comes with extra perks: Once you send your LetsGetChecked test back and receive your results, you get a video conference with a nurse or "medical expert" for further advice, so you're not totally on your own for interpreting the results or dealing with symptoms. 

The company uses UPS Express Shipping (2 days) and has an app where you can access your results, which is either easier or unnecessarily complicated depending on who you are.

To purchase a test, you do have to go through an eligibility assessment (and state that you have mild symptoms and/or exposure), and you will be blocked from ordering if you have severe symptoms and directed to seek medical attention.

This test is also available in Canada, Ireland, and the United Kingdom.

The above tests are the ones we find to be the most worth your money considering they're all highly reliable, offer a fast turnaround, and are covered by insurance or fully reimbursable.

However, different people have different guidelines around what's important to them, so we've gone into the same amount of detail for each test kit below. That way, you have all the information if you are, indeed, considering one of these instead.

CRL Rapid Response 

Pros: Covered by most insurance; can pay with FSA/HSA card; loose eligibility requirements; fast shipping included; calls with results; saliva test

Cons: Requires you to pay OOP and then get reimbursed by insurance; less accurate than other tests

This test is FDA EUA approved, but the sensitivity is 5,400 NDU/mL on the FDA site, which means it's not the most accurate. (Although, FWIW, some tests come back at 180,000 NDU/ml so 5,400 is not as awful as it sounds). The test runs $110 out-of-pocket, including overnight FedEx shipping to and from your location. That price should be reimbursable by insurance and you can use your FSA/HSA card to pay.

You do have to answer questions to determine eligibility for receiving the test (including symptoms and exposure), but you're able to change your answers in order to meet requirements if you so choose. 

The main perks of this option: The results are delivered faster than some competitors thanks to the included overnight shipping (under 48 hours as opposed to 72). And the lab will call with the information so you don't need a smartphone to access results. What's more, it's a saliva test, which is more pleasant than a nasal swab.

Vault Health 

Pros: Lets you pay with FSA/HSA card; no eligibility requirements; medical consultation included; saliva test

Cons: Not covered by insurance; unconfirmed accuracy

Another high-priced, high-tech option is Vault's saliva test, which rings in at $119 — and is out-of-pocket or FSA/HSA card only at checkout; you can submit your receipt to get reimbursed by your insurance company.

Vault Health does not screen for eligibility, making it more accessible in that regard. Once you have your kit, your sample collection is physician-supervised via Zoom, which is a nice feature given that some physicians we spoke with say saliva is a difficult sample to collect. When I tested this kit myself, the practitioner on my Zoom call helped with saliva-generating tips, including smelling vinegar or a jar of pickles (the latter did the trick for me — four quick spits and we were on our merry way).

The test is FDA EUA approved, but accuracy data is not reported yet (a rep from the company told Insider that "IBX submitted data for the reference panel and it's pending review."). Vault Health's test ships via UPS, cannot deliver to a PO Box, and must be returned to a UPS location.

Everlywell

Pros: Covered by most insurance; lets you pay with FSA/HSA card; cheaper than others OOP

Cons: Eligibility requirements; unconfirmed accuracy

One of the first available at-home tests, Everlywell provides a nasal swab PCR for patients who meet their eligibility requirements (mild symptoms and/or known exposure). If you have severe symptoms, you'll be blocked from making a purchase and directed to your healthcare provider. 

The test costs $109 out-of-pocket (or using FSA/HSA) but should be reimbursable via insurance. Two-day shipping is free, but the company also offers overnight shipping at $20 extra (overnight shipping back to the lab is then included).

"While a viable option," says Mick, "consumers have more cost options available than paying $109 out-of-pocket." Additionally, because there is no data on the NDU/mL, it's hard to compare this against the others in this category.

DxTerity 

Pros: No eligibility requirements; widely available via Amazon

Cons: Unconfirmed accuracy; expensive up-front, out-of-pocket cost

There are two main selling points to DxTerity: It is the first at-home saliva test to gain emergency use authorization (EUA) from the FDA for symptomatic and asymptomatic testing, and it's being sold on Amazon. Given its availability on the giant retailer, there is no eligibility assessment and you can use your Prime account for shipping.

This saliva PCR test runs $110 (or 10 tests for $1000) and is reimbursable through some (but not all) insurance plans. DxTerity doesn't list the insurance plans that cover this test but its site says that it is available through participating HSA and FSA plans. Reimbursements need to be filed directly to insurance providers, and the information that's required is listed at the bottom of the FAQ section on DxTerity's website. It's also noted that the American Medical Association set the reimbursement for $100, meaning you won't be able to recoup the entire $110 price tag.

According to the FDA's reference panel, this test is 3,600 NDU/mL, meaning it's not as accurate by comparison to other options in this guide.

Read our full review of the DxTerity test.

Get Tested Now

Pros: No eligibility requirements, pretty accurate

Cons: Not covered by insurance, expensive OOP

This PCR test is highly accurate, doesn't have any pre-requisites for purchase, and is easy to use. But it didn't make our main list because, at $149 entirely out-of-pocket, it's the most expensive test on the list. (The company is out of network for all insurances; you can submit your purchase receipt to your insurance company but it's unclear how likely they are to reimburse you for it.)

What's more, it's not entirely clear how reliable the speed of results is. The lab says you'll hear within 24 to 48 hours once it receives the kit. I took two tests and once, this timeline was indeed the case. But the other time, I didn't hear my results for a full week after I shipped it in; the company later said this was most likely because of winter storms causing shipping delays, so take it as you will. --Rachael Schultz

Ellume

While it's not yet available (the brand is planning to launch in the U.S. sometime in the first half of 2021), this FDA EUA-approved antigen test from Australia is on the radar of several experts we spoke with. It will require a smartphone, but you will be able to get results at home in 15 minutes with no mail-back involved. And it's only $30.

New COVID-19 cases in the US are starting to look a lot like last winter: America just surpassed 100,000 new cases per day, numbers we were seeing eight months ago. A huge part of that surge is thanks to the more contagious Delta variant, which is feeding off loosened mask ordinances and social distancing practices among those who are unvaccinated, but also that it can still mildly infect vaccinated people.

Testing for COVID-19 is important to help slow the spread of the virus across the US. If at-home testing makes infection status more accessible, we need more of it — plain and simple.

The experts I interviewed for this guide also noted the potential risks of in-person testing if we start seeing hour-plus lines at testing centers again like we did last fall and winter, and how at-home testing is an ideal alternative — if it's accessible.

When we spoke with Nadia de la Houssaye, JD, healthcare litigator, attorney, partner and head of the Healthcare Industry Telemedicine Team at Jones Walker LLP in Lafayette, LA, back in January 2021, she pointed out that "the problem with free testing sites, even in areas that offer them, is that they run out of tests quickly and the lines are long." While less demand and better supply chain has fixed most of that, we may start to see a similar scenario if cases keep rising.

Compared to in-person testing, these tests can provide numerous benefits. In-person tests don't provide rapid results, often taking anywhere from a few days to over a week to process and get results back to you, de la Houssaye pointed out. 

Too many roadblocks in infrastructure and accessibility 

Dr. Cassandra Pierre, MD, MPH, MSc, board-certified infectious disease specialist, medical director of public health programs and the associate hospital epidemiologist at Boston Medical Center noted that accessibility of testing is crucial: "[At-home tests] should never, ever be intended to be something like a luxury, or concierge medicine," she told Insider, noting that this at-home testing approach at a luxury level would only serve to widen the gap between socioeconomic classes. 

"The prices are shocking," she said. "A test that costs $110, that requires you to have a smartphone and an app, proximity to a FedEx box, transportation to a FedEx drop box ... it's for someone who has money and wants to travel without the scrutiny of a provider weighing in on their risky behavior."

De la Houssaye agreed: "The likely candidates for purchasing high-dollar at-home kits are middle-aged, middle- to upper-class people who want the testing for at-home convenience, or elderly individuals who have the means to pay and don't want to go to a testing site."

Though it's a good sign there are brands that accept insurance for its tests, or allow insurance to eventually reimburse a payment, that's still only helpful for Americans lucky enough to have insurance. 

Dr. Pierre noted that ideally all of these at-home tests would be free and readily-accessible, regardless of income, location, community, and so on. "I do see these tests becoming more accessible," she added. "We've been advocating for at-home testing since March [2020], but we need to democratize access — it's going to take time, maybe two years, to reach herd immunity with the vaccine. Vaccines are the first bright spot we've had in a really long time, but we will continue to need at-home tests."

Thad Mick, Zoom+Care's vice president of Pharmacy, Laboratory Services, and Imaging Programs, agreed that the accessibility of at-home tests should increase over the coming months. "More companies are working to get their tests to market, so we may begin to see more affordable options like the Ellume, which is expected to cost around $30 once it is available in the US," he said.

And in terms of local accessibility, this may help bridge gaps for those who live in rural areas. "Free test sites are not offered unless enough people in a geographic area have the virus," said de la Houssaye. "Hotspots have more free testing sites than rural areas with low virus counts."

There are a handful of terms that are important to understand in order to correctly interpret all the details of a test kit: 

PCR vs. Antigen

There are two categories of at-home COVID-19 tests: PCR (sometimes called molecular or NAAT) and antigen. Which is best is a hot topic of debate. PCR tests are much more accurate, delivering much lower rates of both false positives and false negatives.

Antigen tests do have their upsides — namely speed and price, as a recent study from the CDC found rapid antigen tests were able to deliver results faster (15 to 30 minutes) and at a lower cost than PCR tests. However, a separate study from the CDC found antigen tests' accuracy dropped by roughly 41% for people who had COVID but were asymptomatic.

Types of collection

Most at-home tests either involve a nasal swab or a saliva PCR test. The collection is what type of sample you're giving — are you giving saliva, or a nasal swab, or your mask, or your blood?

"Recent research from the Memorial Sloan Kettering Center in New York City found that the saliva tests detected the virus at a similar rate to the nasal swab," said Mick.

But Dr. Pierre noted that saliva tests can be difficult for many patients to fulfill as they require a lot of saliva. (Although some find a nasal swab uncomfortable, so it really becomes a personal preference.)

FDA EUA

In normal times, FDA approval is the gold standard we hold all medical tests to. But because that takes time and Americans needed at-home tests STAT, the pandemic gold-standard is expedited FDA-approval during emergencies (FDA EUA). 

Dr. Pierre says this is still a rigorous process with high standards, but perhaps not the same level of scrutiny we see "outside of wartime" (wartime being, well… now). However, it's something you should look for on any kit you're considering because it denotes safety and efficacy (and that you're not wasting your money). 

A legal note about EUA: "Any test kit that is claiming 'FDA approval' should really say 'limited approval pursuant to an FDA Emergency Use Authorization.' The test kits that are given EUA have comprehensive validation data that satisfies the FDA and supports offering a test that won't cause consumer harm and provides results that are accurate enough to support FDA thresholds. Also of importance, these FDA EUAs are only valid during the federal COVID-19 emergency declaration," says Jones Walker attorney, Nadia de la Houssaye, JD, healthcare litigator.

Product/test sensitivity

The sensitivity of a test means how sensitive or perceptive it is to even a low amount of RNA (the genetic material these tests detect) — can it detect the presence of COVID if there's only a tiny bit present? The more sensitive a test, the more accurate it is.

This is measured in nucleic acid amplification test-detectable units per milliliter (NDU/mL). Lower numbers denote more sensitivity (and therefore, more accuracy and more favorability). 

Our experts said you want to look for NDU/mL as opposed to a percent (i.e., 95% sensitivity) since that isn't a truly specific measurement. Thankfully, the FDA created an entire web page outlining the NDU/mL of every available COVID-19 test.

So how do you choose the right test? With so many options cropping up, we also consulted Cassandra Pierre, MD, board-certified infectious disease specialist and medical director of Public Health Programs and the associate hospital epidemiologist at Boston Medical Center who has a background in HIV diagnostics and treatment and has been advocating for at-home HIV testing for the past several years. 

Her metrics for picking a trustworthy test: "These tests should be low-cost, easy-to-use, and have good sensitivity, good reliability, and trustworthy results." 

Other features to keep in mind are an easy ordering process; comfortable, easy-to-use self-collection instructions; and a timely result-reporting structure. It's also smart to check that the test received FDA Emergency Use Authorization (FDA EUA). This can be done by visiting the FDA website. 

Insight from our medical reviewer

During the medical review for this piece, Dr. David Aronoff pointed out that although PCR tests are much more accurate at detecting the virus, they can remain positive for weeks after someone is no longer contagious. And while antigen tests aren't as sensitive, when they do come back positive, this reflects that you're more likely to be shedding a lot of inactive virus, thus making this test a better marker of a person being both infected and contagious.

Yet herein lies the problem: Antigen tests are also more likely to come back falsely negative when someone is contagious, particularly if they're asymptomatic. They are, however, much cheaper and simpler to produce compared to PCR tests.

Dr. Aronoff told Insider that deciding which test is actually best is a little tricky. Since PCR tests are extremely sensitive, is it truly helpful if a positive result doesn't necessarily mean you're still contagious? This is especially true for people without symptoms.

On the other hand, an antigen test is more likely to miss an infection, especially if you're asymptomatic, so you could be walking around with a false negative, shedding the virus unknowingly.

So, which test actually is best?

Leading researchers have pointed out that taking cheaper antigen tests regularly increases the opportunity for it to detect your virus. In this scenario, the best-case would be to use an antigen test and have it come back positive, confirming that you're infected and contagious.

But because a negative antigen test doesn't necessarily mean you're COVID-19 negative, and the whole point of taking a test is to know if you need to quarantine to minimize spreading the virus, we have to err on the side of caution and say: If you're only going to take one test, it's smarter to opt for a PCR test.

A positive result could mean you're quarantining unnecessarily, which, yes, is frustrating and inconvenient. But until we have better access to affordable, repeat antigen tests, this is far safer from a public health perspective than allowing you to go about interacting with others when you're potentially contagious.

For this article, I intensively researched 12+ at-home COVID-19 tests. Some are not yet available (like Lucira Health and Abott BinaxNOW), while others we deemed too expensive OOP at over $150 to warrant your consideration (like the test from Phosphorus). I then tested and am continuing to test as many as possible myself; check back for updates on our first-person account of each kit. 

When testing and researching what at-home test kits were worth your money, I looked at:

Gatekeeping to tests: Some tests require a pre-screening before you're allowed to order. Since doctors I spoke with emphasized the importance of asymptomatic testing to stop the spread of the virus, I wanted to know if someone could order even if they're asymptomatic and regardless of current exposure. 

Ease of access to results: How easy were the results to access? Will the company simply call you with them? Or do you need a smartphone or app to get your results, since this can be a barrier for an older or financially-restricted population? 

Cost and use of insurance: With growing access to free in-person test sites for most people around the country, having to pay for an at-home kit is a huge barrier, especially if you don't have insurance. I looked at how much a test runs OOP, and if you can bill directly to insurance or get reimbursed.

"The ideal at-home test would be priced for repeat testing," says Dr. Pierre, meaning you could test once a week to help control the spread of the virus.

Additionally, as anyone who has ever tried to get reimbursed by their health insurance company knows, the process can be a nightmare — so tests that directly bill insurance for you were favored. Additionally, paying out-of-pocket (even if it will be paid back) is not always an option, especially at these price points of $100 and up.

Type of test: Because PCR tests yield fewer false negatives, I only included PCR tests. See what to look for in a test for more details on PCR vs. antigen.

Approval: I only included tests that are FDA EUA approved, since this is the closest thing we have to quality and safety control at the moment.

Accuracy: How accurate is the test, according to this FDA table focused on NDU/mL? The lower the number, the higher the sensitivity of the test (aka, the more accurate the results).

Shipping: Most of these companies use either FedEx overnight or UPS express, which means you have to either have access to a dropbox location or the ability to schedule (and often pay for) a pickup for your sample. Shipping plays into both timeliness of getting your test and then getting your results, as well as overall cost, as shipping is free for some services but a fee for others.

We tapped a wide range of experts for this piece to help distill the incredibly complex information. Below, you'll find transparent details on every expert's background:

Cassandra Pierre, MD, MPH, MSc, board-certified infectious disease specialist, medical director of public health programs and the associate hospital epidemiologist at Boston Medical Center. Dr. Pierre has a background in HIV diagnostics and treatment and has been advocating for at-home HIV testing for the past several years, so she is familiar with the science of and roadblocks to at-home tests. 

Thad Mick, PharmD, is the vice president of Pharmacy, Laboratory Services and Imaging Programs at ZOOM+Care, a digital and in-person on-demand healthcare provider. He completed his doctoral studies under the combined Pharm.D program of Oregon State University and Oregon Health Sciences University. 

Nadia de la Houssaye, JD, healthcare litigator, attorney, partner and head of the Healthcare Industry Telemedicine Team at Jones Walker LLP in Lafayette, LA. De la Houssaye is advising several leading COVID-19 testing labs in the country about the implementation and access to COVID-19 antibodies testing, focusing largely on patient accessibility to ensure there are as few hurdles as possible.