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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. Additionally, this plan comes with a Part B Premium reduction of $1.30. You must continue to pay paying your reduced 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, you'll pay a $4 copay for preferred generic drugs at a preferred pharmacy, and $20 at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your Part D costs are $0.
Additional Benefits
The Peak Advantage Vista (PPO) plan offers a wide array of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the service. The plan also provides coverage for emergency services, primary care, preventive services, and specialized services such as hearing, vision, and dental. Additional benefits include ambulance and transportation services, along with coverage for home health services and dialysis. The plan also offers medical equipment coverage, diagnostic and radiological services, and other services like acupuncture and an over-the-counter allowance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a copay of $225 for days 1-3, and a copay of $0 for days 4-90, and a copay of $800 for days 1-60. For Inpatient Hospital Psychiatric, you'll pay a copay of $425 for days 1-3, a copay of $0 for days 4-90, and a copay of $800 for days 1-60. Additional days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, Non-Medicare-covered Stay for Inpatient Hospital-Acute and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $275, observation services have a $275 copay, and ambulatory surgical center services have no copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services have an enhanced benefit.
Partial Hospitalization See details
Partial Hospitalization is covered by the Peak Advantage Vista (PPO) plan.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Peak Advantage Vista (PPO) plan. Ground ambulance services have a $250 copay, and air ambulance services have a $290 copay, with no coinsurance. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year, while 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 under 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 three 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 with a $20 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 healthcare 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 $20 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 under the Peak Advantage Vista (PPO) plan, with specific services like the annual physical exam, health education, in-home safety assessment, personal emergency response system (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services not covered. Additionally, Fitness Benefit (Memory Fitness), Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered.
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), with no copay or coinsurance. Prescription hearing aids are covered, with a copay between $599 and $899, while inner ear, outer ear, and over-the-ear hearing aids are not covered, along with OTC hearing aids.
Vision Services See details
Vision services for the Peak Advantage Vista (PPO) plan include routine eye exams, eyewear, and upgrades. Routine eye exams are covered once per year, and eyewear benefits are covered under the Eye Exams Category.
Dental Services See details
The Peak Advantage Vista (PPO) plan covers dental services with a maximum benefit of $3,500 per year, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with a 50% coinsurance, while 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 coinsurance between 0-20%, while other Medicare Part B drugs have coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Peak Advantage Vista (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Peak Advantage Vista (PPO) plan, with a 20% coinsurance for Durable Medical Equipment (DME), Prosthetic Devices, and Medical Supplies. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Peak Advantage Vista (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $25, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $225, Therapeutic Radiological Services have a copay of $60, and 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 or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Peak Advantage Vista (PPO) plan. A doctor referral is required for Cardiac Rehabilitation Services.
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 per day.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $25 copay, and is limited to 20 treatments per year. The plan provides up to $75 for OTC items every three months, and offers a meal benefit for chronic illnesses. 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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