TL;DR The customer pays the insurance provider money. Then the insurance provider allows the customer to spend this money on birth control, be it pills or more invasive medical procedures.
Health insurance benefits
My picture of how insurance works is, I pay the insurance provider a certain amount of money. In return, the insurance provider promises that if something untoward happens to me (e.g. I'm knocked down by a car), they'll pay for my treatment.
That's one possible way for insurance to work. Typically, when it comes to health insurance customers expect it to cover other types of medical expenditures: screening, counseling, vaccination, pregnancy and newborn care, etc. Emergency coverage is only a part of the insurance policy.
Insurance providers usually follow the market and provide a wide array of health care benefits. Some plans might cover massage therapy, gym membership, and nutrition counseling.
Essential health benefits
HealthCare.gov has a page on essential health benefits that must be provided under ACA (What Marketplace health insurance plans cover):
Every health plan must cover the following services:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
As you can see, most of the mandated coverage is not directly related to emergency services. Preventive care alone includes an extensive set of procedures
Birth control mandate
Birth control is listed under "Additional benefits":
Plans must also include the following benefits:
- Birth control coverage
- Breastfeeding coverage
Under the ACA, at least one form of 18 FDA-approved methods of birth control for women must be covered. Contraceptive methods include birth control pills, preventive barriers, emergency contraception, and sterilization procedures.
Sandra Fluke 2012 testimony
In her testimony, Sandra Fluke raised multiple arguments in favor of forcing insurance providers (in particular religious institutions) to cover the cost of medicinal contraceptives for women. Here're some of them:
- Without insurance, women with low income can't afford the cost of contraception.
Without insurance coverage, contraception can cost a woman over $3,000 during
law school. For a lot of students who, like me, are on public interest scholarships,
that’s practically an entire summer’s salary. ... Women ... have no
choice but to go without contraception.
- Women need contraceptive medication for other medical purposes and the blanket refusal to cover contraceptives is dangerous.
A friend of mine, for example, has polycystic ovarian syndrome
and has to take prescription birth control to stop cysts from growing on her ovaries.
Her prescription is technically covered by Georgetown insurance because it’s not
intended to prevent pregnancy. Under many religious institutions’ insurance plans,
it wouldn’t be, ...
In sixty-five percent of cases, our female students were interrogated by insurance
representatives and university medical staff about why they needed these
prescriptions and whether they were lying about their symptoms. For my friend,
and 20% of women in her situation, she never got the insurance company to cover
her prescription, despite verification of her illness from her doctor. Her claim was
denied repeatedly on the assumption that she really wanted the birth control to
prevent pregnancy. ...
... Now, in addition to potentially facing the health complications that
come with having menopause at an early age-- increased risk of cancer, heart
disease, and osteoporosis, she may never be able to conceive a child.
- Allowing insurance providers not to cover contraception sends a wrong message about the importance of female health.
This is the message that not requiring coverage of contraception sends. A
woman’s reproductive healthcare isn’t a necessity, isn’t a priority. One student
told us that she knew birth control wasn’t covered, and she assumed that’s how
Georgetown’s insurance handled all of women’s sexual healthcare, so when she
was raped, she didn’t go to the doctor even to be examined or tested for sexually
transmitted infections because she thought insurance wasn’t going to cover
something like that, something that was related to a woman’s reproductive health.
Her full statement is published on ABC news website.
Answers to specific questions
So, to answer your questions about birth control.
Birth control works best if taken before the event, not after.
In ACA's case, birth control is a set of medical services that includes emergency contraception.
It doesn't sound like something insurance works for because there's nothing to cover.
Health insurance usually includes preventive measures.
Instead of paying the insurance company to cover all costs for contraceptives, I should logically simply buy the contraceptives from a pharmacist.
In many cases, people are already paying for insurance anyway. The choice is then between spending additional money on the contraceptives and using insurance coverage. Some people won't be able to afford contraceptives. Some other people will choose to save money on them. Both cases will lead to an increased number of unwanted pregnancies with all the attendant consequences.