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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 2026, 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 West Virginia Area and Southwest Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $10500.00 (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 $10500.00 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) Medicare plan offers immediate prescription drug coverage with a $0 drug deductible. For Tier 1 preferred generics, you will pay no copay for 1-month or 3-month fills at preferred pharmacies and through standard mail order, compared to a $15 copay for a 1-month supply at standard pharmacies. Tier 2 generic medications cost a low $4 copay for a 1-month supply at preferred pharmacies and standard mail order, while standard pharmacies charge a $20 copay. Higher-tier medications under this plan transition to tiered copayments and coinsurance. Tier 3 preferred brand drugs cost a $42 copay for a 1-month supply at preferred pharmacies and standard mail order, and Tier 4 non-preferred drugs carry a $95 copay. For Tier 5 specialty drugs, you will pay a 33% coinsurance for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The Peak Advantage Vista (PPO) plan offers affordable healthcare coverage, featuring no copay and no coinsurance for primary care visits, telehealth services, and routine preventive care. For specialized medical needs, members pay predictable copays with no coinsurance, including a $95 copay for emergency room visits, a $35 copay for urgent care, and specialist copays ranging from $25 to $40. Inpatient hospital stays are also covered with no coinsurance, though copayments of up to $800 apply depending on the length of the stay. Supplemental benefits are a key highlight of this plan, offering dental coverage up to a $3,000 annual limit with no copay for preventive services and a 50% coinsurance for comprehensive care. Routine vision and hearing exams are highly accessible with a simple $20 copay, and prescription hearing aids and eyewear are partially covered with no coinsurance. Furthermore, members can take advantage of home health care and up to 24 one-way transportation trips per year to plan-approved locations at no copay and no coinsurance.
Inpatient Hospital See details
Peak Advantage Vista (PPO) partially covers inpatient hospital services, as upgrades, additional days, and non-Medicare-covered stays are not covered. Covered acute and psychiatric stays require prior authorization and have no coinsurance, but copayments of up to $800 apply depending on the length of the stay.
Outpatient Services See details
Outpatient services are covered by Peak Advantage Vista (PPO) with no coinsurance, including ambulatory surgical center and blood services at no copay. Medicare-covered outpatient hospital services have a copay of $0 to $275, while observation services require a $250 copay per stay and outpatient substance abuse sessions carry a $40 copay.
Partial Hospitalization See details
Peak Advantage Vista (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Peak Advantage Vista (PPO) covers ground and air ambulance services with a $280 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Peak Advantage Vista (PPO) covers emergency services with a $95 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $35 copay and no coinsurance. Worldwide emergency services are partially covered with a $95 copay and no coinsurance for emergency care, but worldwide urgent coverage and emergency transportation are not covered.
Primary Care See details
Peak Advantage Vista (PPO) provides primary care physician services and telehealth benefits with no copay and no coinsurance. Specialist visits, therapy services, and mental health sessions are covered with copays ranging from $25 to $40 and no coinsurance, though chiropractic care is only partially covered as other chiropractic services are excluded.
Preventive Services See details
Preventive services under the Peak Advantage Vista (PPO) plan are partially covered, offering annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. While health education and memory fitness are included, several additional preventive sub-services—such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy—are not covered.
Hearing Services See details
Peak Advantage Vista (PPO) covers annual hearing exams with a $20 copay, no deductible, and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $399 to $899 and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear prescription devices are not covered.
Vision Services See details
Peak Advantage Vista (PPO) offers partially covered vision services, including one annual routine eye exam with a $20 copay and no coinsurance, while other eye exam services are not covered. Eyewear—including contacts, frames, lenses, and upgrades—is covered with no copay and no coinsurance, up to a $200 annual maximum benefit.
Dental Services See details
Peak Advantage Vista (PPO) offers partially covered dental services up to a $3,000 annual limit, featuring a $20 copay and no coinsurance for Medicare-covered dental. Preventive care like cleanings and exams has no copay and no coinsurance, while covered comprehensive services require no copay and 50% coinsurance; however, implants, orthodontics, maxillofacial prosthetics, and certain diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Peak Advantage Vista (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is available for a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Peak Advantage Vista (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is partially covered by Peak Advantage Vista (PPO) with no copay and a 20% coinsurance, requiring prior authorization for most items. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, diabetic supplies are not covered under this benefit.
Diagnostic and Radiological Services See details
Peak Advantage Vista (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services and outpatient X-rays feature no copay, while diagnostic procedures range from a $0 to $25 copay, diagnostic radiological services start at a $0 copay, and therapeutic radiological services have a minimum copay of $60.
Home Health Services See details
Home Health Services are covered under the Peak Advantage Vista (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Peak Advantage Vista (PPO) with no copay and no coinsurance, though a referral is required. While some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Peak Advantage Vista (PPO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and a prior three-day inpatient hospital stay are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under Peak Advantage Vista (PPO) include acupuncture, which is covered with a $25 copay and no coinsurance for up to 20 treatments per year with prior authorization. Over-the-counter (OTC) items are partially covered with no copay and no coinsurance up to $100 every three months, excluding nicotine replacement therapy and naloxone. Meal benefits and other supplemental services are not covered.
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