A non-government entity
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 2026 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 $9400.00 (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 $9400.00 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:
Sign up for Peak Advantage Vista (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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 cost a low $4 copay for a 1-month supply at preferred pharmacies and through standard mail order, compared to a $20 copay at standard pharmacies. Brand name and specialty medications have higher cost-sharing requirements under this plan. Tier 3 preferred brand drugs carry a $42 copay for a 1-month supply at preferred pharmacies and standard mail order, while Tier 4 non-preferred drugs require 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 with no copays or coinsurance for primary care doctor visits, telehealth services, and routine preventive care. Specialist visits require a $25 copay, while diagnostic lab tests and outpatient X-rays are also covered with no copay. If you need urgent or emergency care, the plan features a $45 urgent care copay and a $125 emergency room copay. For additional health needs, the plan provides preventive dental services and home health care with no copay, along with a $300 annual allowance for eyewear. Major services like durable medical equipment and dialysis require a 20% coinsurance, while inpatient hospital stays carry an $800 copay for the first 60 days. Members also receive up to 24 plan-approved one-way transportation trips per year with no copay and a $100 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Peak Advantage Vista (PPO) with no coinsurance, though prior authorization is required. Medicare-covered acute stays require an $800 copay for days 1 to 60, while psychiatric stays carry a $425 copay for days 1 to 3 and an $800 copay for days 1 to 60 (with no copay for days 4 to 90); additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Peak Advantage Vista (PPO) with no coinsurance, featuring a $0 to $250 copay for outpatient hospital services and a $250 copay per stay for observation services. Ambulatory surgical center and blood services have no copay, while outpatient substance abuse individual and group sessions require a $40 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Peak Advantage Vista (PPO) 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 both ground and air transport. Transportation services are partially covered with no copay or coinsurance for up to 24 plan-approved one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Peak Advantage Vista (PPO) offers emergency services with a $125 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $45 copay and no coinsurance. Worldwide emergency services are partially covered with a $95 copay and no coinsurance for emergency coverage, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Peak Advantage Vista (PPO) covers primary care physician and telehealth services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Other services feature no coinsurance and varying copays, such as therapy services ($30 copay), mental health services ($40 copay), and partially covered chiropractic care ($15 to $25 copay) which excludes non-routine services.
Preventive Services See details
Peak Advantage Vista (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. However, additional preventive services are only partially covered, as services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and alternative therapies are not covered.
Hearing Services See details
Peak Advantage Vista (PPO) hearing services are partially covered, offering routine exams and fittings for a $20 copay and no coinsurance, and prescription hearing aids with copays ranging from $399 to $899 and no coinsurance. OTC hearing aids, alongside 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, offering routine eye exams with a $20 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a combined maximum annual benefit of $300.
Dental Services See details
Dental services are partially covered by Peak Advantage Vista (PPO) up to a $4,500 annual limit, featuring Medicare-covered dental at a $20 copay and no coinsurance, preventive care with no copay and no coinsurance, and comprehensive care with no copay and 50% coinsurance. Specific services such as other diagnostic dental, other preventive dental, 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, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs are covered with 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Peak Advantage Vista (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Peak Advantage Vista (PPO) partially covers medical equipment with no copay and 20% coinsurance, subject to prior authorization. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Peak Advantage Vista (PPO) with no coinsurance, though prior authorization is required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests range from a $0 to $25 copay, diagnostic radiological services start at a $0 copay, and therapeutic radiological services require a copay starting at $60.
Home Health Services See details
Home Health Services are covered by the Peak Advantage Vista (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Peak Advantage Vista (PPO) with no copay and no coinsurance when a referral is acquired, meaning some services are covered. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered in practice.
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 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
Peak Advantage Vista (PPO) offers partial coverage for other services, featuring acupuncture for a $25 copay and no coinsurance, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved