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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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at preferred pharmacies and standard mail order, while standard pharmacies charge a $15 copay for a 1-month supply. Tier 2 generic drugs require a $4 copay for a 1-month supply at preferred pharmacies and standard mail order, compared to a $20 copay at standard pharmacies. For Tier 3 preferred brand drugs, you will pay a $42 copay for a 1-month supply at preferred pharmacies and standard mail order, or $47 at standard pharmacies. Tier 4 non-preferred drugs require a $95 copay at preferred pharmacies and standard mail order, compared to a $100 copay at standard pharmacies. Specialty medications in Tier 5 carry a 33% coinsurance for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The Peak Advantage Vista (PPO) plan offers robust coverage for core medical needs, featuring no copay and no coinsurance for primary care visits, telehealth, and home health services. Inpatient hospital stays require copayments up to $800 with no coinsurance, while outpatient hospital services require up to a $275 copay. Emergency room visits carry a $95 copay, and urgent care visits require a $35 copay, both with no coinsurance. For routine care, the plan provides preventive dental services with no copay and no coinsurance up to a $3,500 annual limit, alongside routine vision and hearing exams for a $20 copay. Members also receive a $200 annual eyewear allowance and a $100 quarterly over-the-counter item allowance with no copay. Most specialist visits and physical therapy sessions require affordable copays ranging from $15 to $40 with no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Peak Advantage Vista (PPO) with no coinsurance, requiring copayments up to $800 per stay and no copay for psychiatric days 4 through 90. Prior authorization is required, and upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Peak Advantage Vista (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a $0 to $275 copay, observation services cost a $250 copay per stay, and outpatient substance abuse sessions have a $40 copay, all with no coinsurance.
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 ambulance services with a $280 copay and no coinsurance for ground and air transport, while transportation services are partially covered with no copay or coinsurance for up to 24 annual one-way trips to plan-approved locations. Transportation to any health-related location is not covered under this plan.
Emergency Services See details
Peak Advantage Vista (PPO) covers emergency services with a $95 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $35 copay, both with no coinsurance. Worldwide emergency services are partially covered with a $95 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Peak Advantage Vista (PPO) covers primary care and telehealth services with no copay and no coinsurance. Specialist visits, therapy, and mental health services require copays ranging from $15 to $40 with no coinsurance, while chiropractic benefits are only partially covered because other chiropractic services are not covered.
Preventive Services See details
Peak Advantage Vista (PPO) preventive services are partially covered with no copay and no coinsurance for services like annual physicals, kidney disease education, and diabetes self-management training. While health education and memory fitness are covered, other additional preventive services—including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling—are not covered.
Hearing Services See details
Hearing services are partially covered by Peak Advantage Vista (PPO), featuring a $20 copay and no coinsurance for routine exams and fitting evaluations, and a $399 to $899 copay with no coinsurance for covered prescription hearing aids. However, OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Peak Advantage Vista (PPO) partially covers vision services, providing one routine eye exam per year 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.
Dental Services See details
Peak Advantage Vista (PPO) covers dental services up to a $3,500 annual maximum, featuring a $20 copay and no coinsurance for Medicare dental, no copay and no coinsurance for preventive care, and no copay with 50% coinsurance for comprehensive services. Dental services are partially covered, as other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics 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 and step therapy may apply. Medicare Part B chemotherapy and other drugs are covered with no copay and 0% to 20% coinsurance, while covered Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Peak Advantage Vista (PPO) 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, though prior authorization is required for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. 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 have no copay, while diagnostic procedures range from a $0 to $25 copay and therapeutic radiological services require a minimum $60 copay.
Home Health Services See details
Home health services are covered by the Peak Advantage Vista (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Peak Advantage Vista (PPO) offers Cardiac Rehabilitation Services where some services are covered with no copay and no coinsurance, subject to a referral. However, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Peak Advantage Vista (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering 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 Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Peak Advantage Vista (PPO), featuring acupuncture with a $25 copay and no coinsurance up to 20 treatments per year, and over-the-counter items with no copay and no coinsurance up to $100 every three months. Meal benefits, nicotine replacement therapy, and naloxone are not covered under this plan.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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