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At-Home COVID Tests: How Accurate Are They? And How Can You Get a Free One?

Everything you need to know about at-home COVID tests

NBCUniversal Media, LLC

With businesses, events and places of work now requiring negative COVID tests in many cases, demand for testing has increased in recent months, but for those using at-home testing methods, how accurate are they?

With Illinois COVID-19 cases spiking, the new omicron variant spreading across the country and winter holidays are approaching, demand for COVID testing has increased.

Free, in-person COVID-19 testing is available across the state. But many are opting for the convenience of at-home COVID tests.

However, concerns were sparked after some tests were recalled due to false-positive results — and some tests are more expensive than others (some, though, are an eligible expense for flexible savings accounts and health savings accounts).

Thursday, President Biden detailed a new COVID mitigation plan requiring private insurers to cover the cost of at-home COVID-19 tests — and make them completely free.

So how can you get a free at-home COVID test? And how accurate are they?

Here's what you should know.

How do I get a free, at-home COVID test?

The White House this week said that the 150 million Americans who have private health insurance will be eligible for full reimbursement after they buy at an-home COVID test.

That includes people insured by their employer as well as those who've bought a plan on the Affordable Care Act's Marketplace, said Lindsey Dawson, an associate director at the Kaiser Family Foundation.

The new rules however don't apply to those on Medicaid and Medicare, although that could change, and those on Medicare with private insurance may be covered.

It's unclear exactly when the new coverage will kick in, and previous tests you've bought likely won't be eligible for reimbursement, Dawson said.

Overall, details of the new plan are vague, and the Biden administration has promised more guidance by mid-January.

Are there different at-home tests? Which one can I get, and where can I get one?

Experts expect that most at-home tests available at pharmacies will be included under the policy.

Testing kits are available at drugstores without a prescription, and a box with two tests typically costs about $25. Swabs, testing solution and instructions are included.

Adults and teens can test themselves. An adult can test a child as young as 2.

Most tests require swabbing about a half inch inside both nostrils, so it may tickle but doesn't hurt. Tests generate a positive result if a viral protein is detected in your sample.

How can I make sure I get reimbursed?

Keep your receipt, said Caitlin Donovan, a spokeswoman for the Patient Advocate Foundation.

"Your normal receipt should be fine — I've even printed out receipts from Amazon — and then you would have to send it in," said Donovan, adding that insurers generally have a reimbursement form they want you to fill out.

"Insurers will generally have a physical mailing address," she said. "They may also have an option for e-submission, meaning you can upload it to their site or email it in."

To send in a more straightforward receipt, Donovan recommends asking the cashier to ring the tests up separately from additional purchases.

The Biden administration has not yet released further information regarding a timeframe of how long it may take for reimburse people who order a test.

What if I don't have insurance? What if I have Medicaid or Medicare?

If you don't have insurance, or if you're covered through Medicaid and Medicare, the White House said it's doubling the amount of free tests it distributes across community centers to 50 million, from 25 million.

You should be able to find one of these centers at your state or local health agency's website.

How accurate are at-home COVID tests?

The most accurate form of COVID testing is a PCR test, though no at-home tests currently authorized offer this method and instead rely on antigen testing.

Chicago's top doctor has said though, that at-home antigen COVID tests are both accurate and convenient.

Referring specifically to the BinaxNow test, which can be purchased at major stores like Walmart, Walgreens and Target, Chicago Department of Public Health Commissioner Dr. Allison Arwady said during a Facebook Live in August, "Especially if your child or you, you know, are having symptoms, it's a very, very good test. If you're not having symptoms, it's still a good test. And it's the one that you can just take it home and have a result of in 15 minutes. It's like a pregnancy test - you see it right off the bat."

Are there false negatives?

According to Dr. Nimmi Rajagopal, the associate chair of the Department of Family and Community Medicine for Cook County Health, the accuracy of the test "depends on the scenario."

"There are, of course, with any tests, there's a ratio of you can get false positives or false negatives and these tests fall in that same realm," she told NBC Chicago. "So it kind of depends on what you're testing for and what the risk is."

At-home tests will miss some infections and in rare cases mistakenly indicate an infection. One popular test misses around 15 out of 100 infections — these are called “false negatives” — and gives a false positive result in about 1 in 100 people who aren’t infected.

Many factors play into the effectiveness of the tests, including timing and type of test. Rajagopal recommends those who have lingering symptoms and known exposure who receive a negative test continue to isolate and monitor, and take another test in a few days or contact their health care provider for further guidance.

Are there false positives?

The FDA issued an alert in early October about the potential for false-positive results with some home COVID-19 tests produced by Ellume, which were sold at various retailers nationwide.

"In recent weeks, we noted an increased chance that Ellume COVID-19 Home Tests from specific lots may provide an incorrect positive result," the company wrote in a statement.

The company also said, "the reliability of negative results is unaffected by this issue and are not included within this recall."

A manufacturing issue is said to be the cause of the problem. The affected test kits are being pulled off store shelves.

The FDA recommends contacting your health care provider, urgent care facility, or other COVID-19 testing site and request a COVID-19 molecular diagnostic test if you received a positive test result with one of the affected lots of the Ellume COVID-19 Home Test in the last two weeks and have not already had a follow-up molecular diagnostic test to confirm the positive test result.

But according to the FDA, "all tests can experience false negative and false positive results."

"Individuals with positive results should self-isolate and seek additional care from their health care provider," the agency said in a release. "Individuals who test negative and experience COVID-like symptoms should follow up with their health care provider as negative results do not rule out a COVID-19 infection."

How do at-home tests get reported to health officials if positive?

Those who test positive are asked to follow the latest CDC guidelines and communicate the results to your healthcare provider, who is responsible for reporting your test results to the state health department.

Arwady said previously that process is not likely happening for every test.

"All of those negatives realistically are not being reported," Arwady said. "We're not counting, you know, it's a fiction that we've ever counted every COVID test."

She added that though many home tests are not being reported, positive results likely are provided to health care providers, then to the health departments.

What's the difference between at-home tests and home collection tests?

Home collection tests involve taking a sample from your home and then sending it to a lab for results.

At-home tests allow for results from a sample and results are available within minutes.

Should I use an at-home test before gathering for the holidays, or traveling?

Some of the most common circumstances in which people may want to take an at-home test is if they've come into contact with someone diagnosed with COVID, they're displaying symptoms of the virus or they're expected to attend a high-risk event, such as a big family gathering.

“We will be using rapid tests to doublecheck everybody before we gather together,” says Dr. Emily Volk, president of the College of American Pathologists, who is planning a holiday meal with six vaccinated family members. “We’ll be doing it as they come in the door.”

Most takeaway at-home tests purchased at Walgreens won't provide results you can use before a flight or cruise. Check the CDC guidelines to see which COVID-19 tests are approved if you need one before you travel.