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Peak Advantage Vista (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Peak Advantage Vista (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Peak Advantage Vista (PPO) in 2025, please refer to our full plan details page.
Peak Advantage Vista (PPO) is a PPO plan offered by West Virginia United Health System, Inc. available for enrollment in 2025 to people living in North Central and South Western West Virginia. The overall rating for this plan is not yet available for 2025.
It's important to know that Peak Advantage Vista (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Peak Advantage Vista (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Peak Advantage Vista (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10750.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10750.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Peak Advantage Vista (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions. For example, a preferred generic drug has a $4 copay at preferred pharmacies, $20 at standard pharmacies, and $4 through the mail. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. This plan may have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Peak Advantage Vista (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services and primary care visits have copays ranging from $0 to $275. Emergency services and ambulance services have copays, and transportation to health-related locations is covered up to 24 one-way trips per year. This plan covers hearing, vision, and dental services, with specific copays, coinsurance, and annual maximums. It also includes benefits for home health, home infusion, dialysis, and medical equipment with specific copays and coinsurance. Other services such as acupuncture and OTC items are included, as well as a meal benefit.
Inpatient Hospital See details
Inpatient Hospital coverage requires prior authorization and includes both acute and psychiatric care. For Inpatient Hospital-Acute, you will pay a copay of $225 for days 1-3, and $0 for days 4-90, and a copay of $800 for days 1-60. For Inpatient Hospital Psychiatric, you will pay a copay of $425 for days 1-3, and $0 for days 4-90, and a copay of $800 for days 1-60. Additional days, and non-medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $275, and observation services with a $175 copay per stay. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the Peak Advantage Vista (PPO) plan. There is no information about the cost of services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for all ambulance services with a $290 copay, and transportation services to plan-approved health-related locations, with 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Peak Advantage Vista (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $95 copay, while Urgently Needed Services have a $35 copay; all services have no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Peak Advantage Vista (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $25 copay, mental health specialty services with a $40 copay for individual and group sessions, podiatry services with a $25 copay, other health care professional services with a copay between $0 and $25, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits, and opioid treatment program services with a $35 copay. Routine chiropractic care has a $25 copay for up to 10 visits per year.
Preventive Services See details
Preventive Services are covered by the Peak Advantage Vista (PPO) plan. However, the plan does not cover annual physical exams, and many additional preventive services such as health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
The Peak Advantage Vista (PPO) plan covers hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 per year). Prescription hearing aids are covered with a copay between $599 and $899, per hearing aid, per ear, per year, but inner ear, outer ear, and over the ear hearing aids are not covered, and neither are OTC hearing aids.
Vision Services See details
Vision services are covered, including routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), and upgrades. There is a maximum benefit of $200 per year for eye exams, and routine eye exams are limited to one per year.
Dental Services See details
The Peak Advantage Vista (PPO) plan offers a dental services benefit with a $3,000 maximum per year for both in-network and out-of-network services. Oral exams, dental X-rays, cleanings, and fluoride treatments are covered with limitations on the number of visits, while restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with a 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Peak Advantage Vista (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the Peak Advantage Vista (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit has a coinsurance, and Prosthetic Devices have a 20% coinsurance. Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, are covered with a copay between $0 and $25; lab services have no copay. Diagnostic radiological services have a maximum copay of $225, while therapeutic radiological services have a minimum copay of $60; outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Peak Advantage Vista (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
For the Peak Advantage Vista (PPO) plan, Cardiac Rehabilitation Services are not covered. A doctor referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $25 copay and requires prior authorization, with a limit of 20 treatments per year. This plan provides OTC items as a supplemental benefit, with a maximum benefit coverage amount of $75 every three months. The meal benefit is for a chronic illness. Other services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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