The question is “What else”. I’ve struggled for years with Fastmail and I’m not competent enough to buy O365.
Buy your own domain and run mox (https://github.com/mjl-/mox) on it. In the setup it provides details on the DKIM info you need to put into your DNS records. Get a PTR record from your ISP (if hosting at home); periodically check your blocking from spamhaus etc.
I run mine on a Pi4 no problem whatsoever, but I guess a VPS could also be used, although the scamalytics analysis will show it's a server or an IP shared with an anonymising VPN etc. if it's a shared IP on the host.
I have run my mail there for 10 years and it was smooth sailing. Until they've raised prices two-fold but I digress…
For me Migadu has been good
For personal or family, I think Fastmail is fine. I use it for a family account (paid years in advance), and admin other Fastmail tenants "family office" style for those who trust me to and offload the responsibility. I can get ahold of someone at Fastmail easily when issues crop up, which is rare. O365 is what I recommend for anything SMB and up. You can at least get support from Microsoft when needed. AWS is fine for cloud resources and infra, again, you can get support from a TAM or similar. But Google? I have never once had a good experience attempting to get in touch with a human when resolution is needed, hence my position on the topic. You cannot self serve critical business infra (imho), and Google is allergic to providing human support.