Considering an at-home COVID test before a trip? What travelers need to know

·13 min read

Whether you're traveling abroad or visiting family this winter, health experts say at-home coronavirus tests can be a convenient way to reduce the risk of spreading the virus.

While the tests have been expensive and hard to find in recent months, the Biden administration is working to make at-home tests more accessible. The White House announced earlier this month that it will distribute more tests to health centers and rural clinics and have private insurance providers offer reimbursements. On Tuesday, the administration announced that Americans will soon be able to have free at-home tests mailed to their homes.

The announcement is part of the administration's plan to combat the delta and omicron variants this winter.

"We’re taking even more steps to make it easier to get tested and get tested for free," President Joe Biden said Tuesday.

From accuracy to pricing, here's what travelers should know about at-home coronavirus tests:

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► COVID-19 updates: First confirmed US case of the omicron variant detected in California

How soon can I get free at-home tests?

The Departments of Health and Human Services, Labor and Treasury are set to issue guidance by Jan. 15 that would allow over-the-counter coronavirus diagnostic tests to be reimbursed by group health plans or health insurance providers. The U.S. Food and Drug Administration has authorized eight over-the-counter tests that are on the market today.

Americans who do not have private insurance will also be able to access free at-home tests at community sites. The Biden administration said it would distribute 50 million tests to community sites and rural clinics, double the count pledged in September.

Also starting in January, Americans will be able to request free at-home coronavirus tests that can be ordered online and mailed to their address.

► Free at-home COVID tests: Biden to promote COVID-19 plan that includes free at-home tests and new travel rules

How do at-home tests work?

At-home rapid tests, also referred to as self-tests, are different than the PCR tests travelers can take at a pharmacy or lab. While PCR tests are used to identify if someone has been infected, many of the over-the-counter home testing kits are rapid antigen tests that can detect whether a person is infectious.

The main advantage of rapid antigen tests is their speed. The tests can provide results within 15 minutes, whereas some PCR test results can take days.

"Generally, what people want to know when they're getting a test for the holidays is: Am I a risk to somebody? Am I potentially infectious right now?" said Michael Mina, a former Harvard epidemiologist recently named chief science officer at telehealth company eMed. "For that answer, these rapid tests are really crucial because they're fast, so they actually give you real-time information, not information about your status three days ago."

A COVID-19 home rapid testing kit in Miami on May 20, 2021.
A COVID-19 home rapid testing kit in Miami on May 20, 2021.

Although speed is a major advantage, rapid tests are less sensitive than PCR tests and may not detect COVID-19 if the viral load is low. Accuracy rates improve for people who are experiencing symptoms.

Testing methods vary between brands. Some at-home tests require a nasal swab, while others ask for a saliva sample. Travelers can also choose between tests that offer results in minutes and others that can be mailed into a lab and analyzed.

Whatever at-home test you prefer, the Centers for Disease Control and Preventionsuggests people wash their hands with soap, clean the surfaces where the testing will take place, check the expiration date before use, and follow instructions carefully.

How accurate are the at-home COVID test kits?

Health experts say rapid at-home antigen tests are not as accurate as PCR tests, which are often tested in a lab and can take hours to process.

"People should know that they are more likely to be accurate if you have symptoms," said Rebecca Fielding-Miller, assistant professor of public health at the University of California, San Diego. "They are generally less accurate than the PCR – the diagnostic tests you would get through your county or your provider."

False positives and false negatives are rare, although possible, with self-tests. The CDC found Abbott's BinaxNOW rapid antigen test was less sensitive than PCR tests with asymptomatic users. The test correctly gave a positive result 85% of the time compared to a PCR test, and correctly gave a negative result 99% of the time.

The Quidel Quickvue rapid antigen test correctly gave a positive result 84% of the time for people with symptoms and correctly gave a negative result 99% of the time.

Ellume reports that its home test results are 96% accurate, but the company had to recall more than 2 million tests this year because they were giving "higher-than-acceptable" false-positive test results.

► COVID test recall: Ellume recalls hundreds of thousands of home coronavirus test kits over false positive concerns

Spokespeople for Ellume declined to comment.

When should I use an at-home test?

Many health experts said they planned to take at-home tests before their own family gatherings during the holiday travel season.

"If we know that everyone in the room ...has been tested negative just hours earlier, then that creates a much much safer environment," Mina said. "We know that … nobody is actively infectious and spreading the virus to each other, so you can be much more comfortable taking off your mask and enjoying the evening."

Fielding-Miller, who has a stack of self-tests ready for emergency use, said people who develop COVID-19 symptoms can opt for at-home tests, especially if they have plans to visit others.

"If you have a little cough or a cold and you're really nervous and you're about to go see Grandma, it's amazing and really reassuring to have that on hand. Especially, if you're you're already vaccinated. It's a nice way to double-check and make sure that things are OK," she said. "I think everybody should have five of these in their bathroom, just ready to go at all times."

Kevin Ban, Walgreens' chief medical officer, suggests PCR or RNA amplification tests for people who are traveling and asymptomatic who have not recently been exposed to the virus. PCR test results often come back within two to three days, although some locations offer faster (and often more expensive) rapid PCR tests. RNA amplification test results come back within about 24 hours, Ban said. Both are available in select pharmacy drive-thrus.

"Those are the most sensitive tests and usually good for assurance testing," Ban said. "(At-home rapid antigen tests) are very good when a person is symptomatic (or) when a person does testing on a serial basis."

Can travelers returning to the U.S. use self-tests?

The CDC requires all international air travelers 2 and older take a viral test (such as an antigen test or nucleic acid amplification test) before entering the U.S.

The country accepts certain self-tests, which means travelers can purchase the tests before their trip and pack them to use before their return flight. The U.S. only selects self-tests that meet certain criteria:

  • It must be either a nucleic acid amplification test or antigen test granted Emergency Use Authorization by the U.S. Food and Drug Administration.

  • Testing must include remote supervision from the manufacturer so the telehealth proctor can confirm that the person’s identity and test results. Some tests with telehealth services may require a prescription.

  • Airlines and aircraft operators must be able to review and confirm a traveler’s identity and test result details.

► Omicron variant: More travel restrictions as new variant emerges

The testing options that are suited to international travelers entering the U.S. include:

  • Abbott’s BinaxNOW COVID-19 AG Card Home test (the company’s BinaxNOW antigen self-test, which is available over the counter, is not eligible for travel purposes).

  • Ellume COVID-19 Home Test.

Stephen Kissler, a postdoctoral fellow at the Harvard T.H. Chan School of Public Health, noted that more international travelers may be opting for at-home tests after the CDC on Dec. 6 tightened testing requirements for international air travelers, dropping the pre-departure testing window from three days to one.

"In most places, it's difficult to get a one-day turnaround on a PCR test," Kissler said. "So I anticipate that these (tests) are probably going to have to be some form of rapid test," including at-home tests.

How much do at-home COVID tests cost?

Free at-home tests in the U.S. won't be available until January. If you're looking to buy a rapid at-home test for international travel in the meantime:

  • A six-pack of the BinaxNOW home test can be purchased on eMed for $150 (shoppers are limited to one item per order), or as a three-pack for about $100 through Optum. The test is not available over the counter.

  • The Ellume home test is available for international travel through Azova, and available at retailers including Amazon, Target, Walmart, CVS and Everlywell, according to its website. Prices for the test start at around $25, but some sites warn that they are out of stock. (More than 2 million Ellume tests have been recalled in the U.S.) Video observation from Azova costs $20.

If you're looking to buy an over-the-counter at-home test, popular brands include:

  • Abbott’s BinaxNOW COVID-19 Antigen Self Test (A two-pack costs about $24 at CVS and Walgreens and $14 at Walmart).

  • Pixel by Labcorp COVID-19 PCR Test Home Collection Kit (About $125 at CVS and Walgreens).

  • QuickVue At-Home OTC COVID-19 (A two-pack costs about $24 at CVS and Walgreens and $25 at Everlywell).

  • InteliSwab’s COVID-19 Rapid Antigen Home Test (A two-pack is about $24 at Walgreens and $14 at Walmart).

  • Intrivo Diagnostics’ On/Go COVID-19 Antigen Rapid Self-Test (A two-pack is about $24 at Walgreens).

Buyers should be prepared to find some tests unavailable at certain retailers.

Where can I buy a COVID test kit?

At-home tests have been difficult to track down in recent months, with some consumers comparing them to the toilet paper and hand sanitizer shortages in the early days of the pandemic.

The Biden administration has been working to ramp up the availability of the tests and is spending nearly $2 billion total to procure more than 280 million kits and announced that retailers Amazon, Kroger and Walmart will sell kits at a discount of up to 35% from retail prices.

The Abbott BinaxNow  coronavirus self-test.
The Abbott BinaxNow coronavirus self-test.

Abbott, which is behind one of the most popular at-home tests in the country, scaled up manufacturing and is now making more than 50 million tests per month, according to spokesperson John Koval.

"As breakthrough infections continue to occur, air travel resumes, and people head indoors as the weather changes, we see a critical role for rapid testing – especially as people celebrate the holidays and return to their pre-pandemic lifestyle," Koval said in an emailed statement.

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Walmart offers the BinaxNow in-store and online and the Inteliswab on its website, along with a few other tests sold by other sellers through its marketplace. Spokesperson Tricia Moriarty told USA TODAY that the company has seen high consumer demand for the past few months, but has “been able to increase our inventory both in-store and online in recent weeks.”

Walgreens offers four over-the-counter tests: Abbott’s BinaxNow, the Everlywell COVID-19 Test Home Collection Kit, QuickVue At-Home OTC COVID-19 Test Kit and the Pixel by Labcorp COVID-19 PCR Test.

Some health experts worried that shoppers might have trouble finding the tests in stores over the holidays.

“We’re delayed putting resources, as a nation, into these tests until very recently. So for the holidays, we're going to see that there's going to be a shortage,” Mina said. “Still today, in much of the country, you can’t just walk into your CVS or Walgreens and just assume you’ll be able to pick up a test.”

Retailers like Walgreens, CVS and Amazon have started limiting the number of testing kits consumers can purchase due to increased demand spurred by the spread of omicron.

Amazon shoppers can buy no more than 10 of its branded at-home testing kits, CVS is restricting buyers to six over-the-counter testing kits while Walgreens limits shoppers to four over-the-counter antigen tests at its pharmacies.

"As the nation experiences a surge in COVID-19 cases coinciding with the holidays, we are seeing unprecedented demand for related testing and vaccine services and products," Walgreens said in a Tuesday statement.

► At-home COVID tests: Amazon places limits on sales amid spike in demand

Yaritza Higgns, 27, takes a COVID-19 self test at the free, walk-up coronavirus testing site at the Crescent Court public housing complex in Brockton, run by Brockton Area Multi-Services Inc. through the state's Stop the Spread program, Thursday, Aug. 13, 2020.
Yaritza Higgns, 27, takes a COVID-19 self test at the free, walk-up coronavirus testing site at the Crescent Court public housing complex in Brockton, run by Brockton Area Multi-Services Inc. through the state's Stop the Spread program, Thursday, Aug. 13, 2020.

Does Hawaii accept at-home tests?

Unvaccinated U.S. citizens will have to show proof of a negative coronavirus test to enter Hawaii. The state accepts select at-home results provided by the state's testing partners, including:

  • Costco/AZOVA: The at-home observed saliva test is available at Costco for travelers 5 and older. The test is shipped overnight to a lab, where results should be ready within 12 to 48 hours after arrival. The test costs about $115, according to Costco's website. The store also offers in-pharmacy testing for travelers in select markets.

  • Vault Health: Travelers five and older can take this saliva test at home with real-time supervision via video chat. Results are mailed back within 72 hours.

Do cruises accept at-home test results?

The CDC recommends people get tested one to three days before a cruise and three to five days after, regardless of vaccination status.

How long is the shelf-life for these tests?

Expiration dates vary by brand, but some can last up to a year. Earlier this year, the FDA extended the shelf life for Abbott’s BinaxNOW COVID-19 Ag Card to 12 months.

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Contributing: Ken Alltucker, USA TODAY

Follow USA TODAY reporter Bailey Schulz on Twitter: @bailey_schulz.

This article originally appeared on USA TODAY: At-home COVID-19 tests: What travelers need to know