5. How We Compare — Our Competitive Advantage
Here is how our Optimum Health Saver stacks up against the market:
|
Factor |
ACA (Unsubsidized) |
Our Plans (Optimum) |
|
Monthly Premium |
$400–$800+ (individual) |
Often $200–$450 (varies by age/state) |
|
Doctor Network |
Often narrow — specific plans only |
First Health LBP PPO — broad access |
|
Deductible |
$3,000–$8,000 |
$5,000 (hospital admission only — applies only when admitted 24+ hours) |
|
Prescription Coverage |
Included — valuable for expensive brand-name drugs with manufacturer co-pay assistance programs; for simple generics, ACA co-pays are often more expensive than just paying cash through GoodRx |
Not included — GoodRx/Lone Star Rx cash pricing typically beats ACA co-pays on generics |
|
Maternity Coverage |
Included |
Not included — refer to ACA |
|
Pre-existing Conditions |
Must cover |
Underwritten — see UW guide |
|
Enrollment |
Annual open enrollment |
Anytime — no enrollment window |