The Rodriguez Family — Case Study

Case Study · Individuals & Families

The Rodriguez Family

Carlos (41), independent contractor. Maria (38), part-time worker. Two kids, ages 8 and 11. Buying ACA marketplace coverage on their own.

Before OptimalMD — Annual Healthcare Reality

ACA Silver plan premium (after subsidy)$13,680/yr

Family deductible — paid most care out-of-pocket$6,000

Carlos's urgent care — 2x sinus infections$580

Maria's thyroid medication (generic)$564/yr

Kids' annual physicals through insurance$380

Maria's therapy — 3 sessions before stopping due to cost$450

Total annual spend (before) $15,654

After OptimalMD Prime — Same Family

OptimalMD Prime Family — all 4 covered$1,788/yr

Carlos's urgent care — unlimited virtual$0

Maria's thyroid medication — on $0 generic list$0

Kids' annual physicals — virtual primary care$0

Maria resumes weekly therapy — unlimited included$0

GLP-1 for Carlos (lost 30 lbs) — no pre-diabetic codeIncluded

Total annual spend (after) $1,788

Annual savings

saved in year one · $69,330+ over 5 years

$13,866

The Williams Family — Case Study

Case Study · Individuals & Families

The Williams Family

David (55) has high blood pressure and high cholesterol. Linda (52) manages type 2 diabetes with metformin. Family HDHP through David's employer at $1,800/month.

Their Annual Healthcare Reality

Family HDHP premium$21,600/yr

David's lisinopril + atorvastatin$888/yr

Linda's metformin + insulin + supplies$2,640/yr

4 primary care visits for medication management$800

Annual labs (out-of-pocket)$480

Total annual spend (before) $26,408

After OptimalMD Prime + Impact Health Sharing

OptimalMD Prime Family$1,788/yr

Lisinopril + atorvastatin — on $0 generic list$0 (saves $888)

Metformin — on $0 generic list$0

Insulin + supplies — dramatically reduced via OptimalRxReduced

All doctor visits and labs$0

Impact Health Sharing for major medical~$650/mo vs. $1,800

Total annual spend (after) ~$9,588

Annual savings

estimated annual savings

$16,820

Jennifer M. — Case Study

Case Study · Individuals & Families

Jennifer M.

Single professional, 34, marketing at $72,000/year. Employer-sponsored HDHP with $2,500 deductible — paying $487/month out of her own paycheck.

Her Annual Healthcare Reality

Monthly premium (employee share)$5,844/yr

Two doctor visits — $185 each out-of-pocket$370

Antidepressant (generic) at $28/month$336/yr

Dermatology visit (mole check)$320

Therapy — wanted but could not afford $150/sessionSkipped

GLP-1 — doctor requires a pre-diabetic codeAvoided

Total annual spend (before) $6,870

After Adding OptimalMD at $99/Month

Keeps employer plan for catastrophic coverage onlyRetained

All routine visits through OptimalMD$0

Therapy — going weekly, fully private$0

Antidepressant through OptimalMD$0

GLP-1 — NO pre-diabetic code, NO MIB report$0 code risk

Lost 24 lbs · blood pressure normalized✓ Health outcome

Life insurance — standard rate, no metabolic flags-$340/yr saved

Total annual spend (after) $1,188

Annual savings

annual avoided costs + life insurance savings

$2,400+

The GLP-1 privacy protection alone — by avoiding a pre-diabetic code — saves Jennifer up to $10,750 in excess life insurance premiums over a 25-year term policy.

Employer · Logistics

Regional Logistics Company — 45 Employees

45-employee owner-operated trucking company. Annual renewal arrived — 11% increase on top of $206,400/year. Owner was weeks from dropping coverage entirely.

The Situation Before OptimalMD

Group health insurance $206,400/yr

11% renewal increase proposed +$22,704/yr

New plan: $5,000 individual deductible — employees furious Morale crisis

Drivers quit in past year citing benefits frustration 3 drivers lost

Turnover replacement cost per driver $12–18K each

Total annual spend (before) $206,400/yr

After Implementing OptimalMD Prime + Impact Health Sharing

OptimalMD Prime Family for all 45 employees $80,460/yr

Impact Health Sharing for major medical ~$102,000/yr

Total new annual benefit cost $182,460

Direct annual savings vs. previous plan $23,940

Avoided 11% renewal increase +$22,680 saved

Turnover in 12 months post-switch 0 turnover

Avoided 2 potential turnover events $24–36K saved

Total annual spend (after) $182,460/yr

First-year total financial impact

direct savings + avoided increase + turnover prevention

$82,620

Employer · Tech

Series A SaaS Company — 18 Employees, Competing for Talent

A Series A SaaS company losing engineering candidates to larger competitors — while spending $170,400/year on a plan their own team called "bare minimum."

The Competitive Positioning Problem

Basic group health plan $170,400/yr

Plan perceived by candidates as "bare minimum" Talent risk

Engineers citing better benefits elsewhere Losing deals

Promising hires who declined — citing better benefits 2 lost hires

Engineers with families — can't afford dependent add-on Excluded

Total annual spend (before) $170,400/yr

After Redesigning Benefits Around OptimalMD Prime

OptimalMD Prime FAMILY plan — all dependents covered $32,184/yr

Impact Health Sharing for major medical ~$40,800/yr

Total new benefit cost $72,984/yr

Annual savings vs. previous plan $97,416/yr

Candidates who previously declined — now accepted 2 engineers hired

Total annual spend (after) $72,984/yr

Annual savings + 2 top engineers hired

benefits became a competitive weapon vs. FAANG-adjacent competitors

$97,416

The talent narrative became a competitive weapon. Offering "$0 doctor visits for your whole family" proved more compelling than the old HDHP — even against FAANG-adjacent competitors.

Individuals
Employers
$0 Medications $0 Diagnostic Lab Tests

$0 Telehealth Visits

Urgent Care Primary Care Dermatology Psychology & Psychiatry Patient Care Coordination

$0 to Message 13 Specialists

Women's Health General Practitioner Pediatrician Allergist Psychologist Dietician Sports Medicine Alternative Medicine Pharmacist Ophthalmologist

$0 Licensed Therapists $0 for My AI Doctor™ – Diagnosis Companion Weight Loss Program (GLP-1)
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