We’ve been getting a lot of questions lately from people concerned about losing their current health insurance coverage before the “guaranteed” coverage provided by the Affordable Care Act (ACA) becomes available. If it actually does.

Some of these letter-writers say that their employers plan to discontinue coverage, whether or not the ACA is overturned by the Supreme Court or repealed by a future congress. These questions seem to reflect a general anxiety about the current state of the health insurance marketplace. And a few sound a bit like urban legend—most polls on the subject indicate that employers do not plan to cut health coverage this year or next. (Or, at least, they won’t admit such plans to pollsters.)

Regardless of anxiety or opinion polls, the fact is that various laws at the federal and state levels make it difficult for employers to discontinue health insurance benefits, once started. But, in the interest of clearing up confusion, we’ll answer the main question: What happens if your employer decides to cut off your health coverage? For starters, the decision probably won’t take effect immediately. The federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) applies to all companies with more than 20 employees and controls how insurance benefits are managed.

COBRA is most relevant to insurance consumers because it requires employers to make existing coverage available to former employees, in most situations, for between 18 and 36 months after the employee becomes “former.”

COBRA coverage isn’t free to the former employee; you have to pay your former employer the monthly premium (plus up to 2 percent more to cover the former employer’s administrative costs). This can be expensive, especially if the ex-employer has an older employee population and is paying a higher group premium. But the former employer must make the coverage available; and, for people with health problems, COBRA coverage is often a better deal than individual-coverage alternatives. COBRA rules also apply when an employer decides to discontinue health insurance benefits. Effectively, the law requires the employer to give employees advance warning of the discontinuation—and must make the benefits available for at least the COBRA-minimum 18 months available to former employees.

If you’re in good health, COBRA coverage may not be so important. You may be able to buy any of several types of individual health policy for the same price. Or less. But, as we’ve noted, if you are (or have a dependent who is) in poor health or have pre-existing conditions, keeping COBRA coverage will usually be your best strategy.

The 18- to 36-month COBRA period is intended to give you enough time to search for either a new job or an individual policy that suits your needs. The key here is to make sure that you start that search right away—especially if you have a health history that will make finding good individual coverage difficult. The goal, from the beginning, should be to have a solid solution in place well before you run out of time on COBRA. We hear from many letter-writers who wait until their COBRA coverage ends to start looking for other coverage. That’s dumb.

One last note on COBRA coverage: The federal law allows individual states to follow their own laws instead, as long as those state laws at least match standards set by the federal version. For example, Connecticut state insurance law (CGS § 38a-538) requires employers to allow “individuals to elect to continue coverage under a group plan pursuant to federal extension requirements established by” federal COBRA. And, if an employer decides to discontinue health coverage, it has to wind down the benefit over a period of at least 18 months. So, check with your state’s Department of Insurance about which laws apply. But the fact is that, because of COBRA’s long wind-down period, many employers trim away at coverage rather than eliminate it altogether. Or they pass a greater portion of premium payment to employees, often under the rubric of “cost-sharing.”  Still, if your employer does end all health insurance coverage—or if its COBRA coverage is extremely expensive—you can buy yourself additional time to find a long-term solution by using short-term or “temporary” health insurance coverage.

(At this point, some nit-picking readers may point out that all health insurance is temporary, since it’s usually set up on a one-year term. But, as we’re about to see, the insurance industry considers “temporary” to mean a policy with an ever shorter term.)

Some common traits of short-term health insurance:

• generally lasts up to 11 months;
• may be renewable for one or two additional 11-month terms;
• some policies are structured as one-month contracts, renewable for a longer term (six to 11 months);
• even though most short-term policies have simplified applications, underwriting is strict; if you’ve ever been denied health coverage, you probably won’t qualify;
• the underwriting process will consider an applicant’s height and weight;
• generally, all insured persons must be under the age of 65;
• pre-existing condition limits and other exclusions are often strict and “look back” as much as 36 months (this varies by state);
• typical policies do not pay for routine preventative care such as physical exams, immunizations, and PAP tests;
• generally short-term policies have high deductibles, starting at $500 and going as high as $5,000 or ever $10,000;
• lower deductibles will usually be followed by 80/20 co-pay to $5,000 or $10,000, followed by full coverage;
• as of early 2012, short-term policies were available in all states except Massachusetts, New Jersey, New York and Vermont.

Though their coverage is limited, these policies have been growing in popularity over the past decade. They’ve really taken off as a low-cost alternative to COBRA coverage. By some estimates, as many as 16 million Americans have been buying temporary health insurance each year in the early 2010s. And the growth in market size has driven premiums down. A short-term health insurance policy usually operates like an indemnity plan, which means you will have the ability to see any doctor or specialist you choose. However, most short-term policies require pre-certification of treatment.

“Pre-certification of treatment” is a process whereby you have to obtain prior verbal or written authorization from the insurer for any covered:

• hospital admission;
• inpatient procedure, therapy or treatment; or
• outpatient surgery.

Here is standard pre-certification language from a short-term policy:

At the time notification of surgery is made, We will inform the Insured and his or her Provider if a second opinion is required, at the expense of the Company, before certification will be given and will assign a length of stay if it is determined that Inpatient hospital care is Medically Necessary. We may extend the length of stay upon the request of the insured or the Provider if We determine an extension is Medically Necessary. No benefits will be Provided under this Policy for expenses that are determined not to be Medically Necessary.

Treatment Provided at any time after initial certification that differs from the specific plan of care and treatment previously authorized requires re-certification by Us. While some short-term policies are renewable for 30 months or more, the insurers may refuse to issue a second or third policy if you have filed any claims under your previous short-term policy. Others may offer another policy—but will treat any injuries or illnesses that occurred during the previous short-term policy as ore-existing conditions and won’t cover treatment related to those conditions in the new term.

So, if your employer really does discontinue health coverage, your two best tools for buying time to find new coverage are: the required COBRA wind-down period; and the short-term health policy. Between them, these tools should give you from a few months to three years to find a long-term solution.

Just don’t wait until the interim options expire to start looking for that.