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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 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 $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 dollar drug deductible, meaning prescription 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 dollar copay for a 1-month supply. Tier 2 generic drugs cost 4 dollars for a 1-month supply at preferred pharmacies and standard mail order, compared to a 20 dollar copay at standard pharmacies. For brand and higher-tier medications, Tier 3 preferred brand drugs carry a 42 dollar copay for a 1-month supply at preferred pharmacies, while Tier 4 non-preferred drugs cost 95 dollars. Standard pharmacies charge slightly higher copays of 47 dollars for Tier 3 and 100 dollars for Tier 4 for a 1-month supply. Specialty drugs in Tier 5 require a 33 percent 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 copay and no coinsurance for primary care visits, preventive services, and home health care. For specialized care, beneficiaries can expect low copayments starting at $15 for specialist visits and no coinsurance for most diagnostic services. Inpatient hospital stays require copays of up to $800 with no coinsurance, while emergency room visits carry a $95 copay that is waived if you are admitted. This plan also features strong supplemental benefits, including no copay for routine eyewear and preventive dental care, alongside a $3,000 annual maximum for dental services. Additionally, members can access up to 24 one-way transportation trips per year and over-the-counter items up to $100 every three months with no copay. Routine hearing and vision exams are available with a low $20 copay, making it easy to manage your everyday wellness needs.
Inpatient Hospital See details
Peak Advantage Vista (PPO) inpatient hospital services are partially covered with no coinsurance, requiring prior authorization and copayments of up to $800 depending on the length and type of stay. Additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Peak Advantage Vista (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services carry a copay ranging from $0 to $275, observation services require a $250 copay per stay, and outpatient substance abuse sessions have 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 ground and air ambulance services with a $280 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Peak Advantage Vista (PPO) with a $95 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, while urgently needed services require a $35 copay and no coinsurance. Worldwide emergency services are partially covered with a $95 copay and no coinsurance, but 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, while other services like specialist visits, therapies, and mental health care have copays ranging from $15 to $40 with no coinsurance. Chiropractic care is partially covered, as other chiropractic services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Peak Advantage Vista (PPO) with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and memory fitness. However, many additional services are not covered, including medical nutrition therapy, weight management programs, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Peak Advantage Vista (PPO) covers hearing exams, including routine exams and fittings, for a $20 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay between $399 and $899, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Peak Advantage Vista (PPO) covers routine eye exams with a $20 copay, no coinsurance, and no deductible, up to a $200 annual maximum, though other eye exam services are not covered. Eyewear, including contacts, lenses, and frames, is covered with no copay, no coinsurance, and no deductible.
Dental Services See details
Peak Advantage Vista (PPO) partially covers dental services up to a $3,000 annual maximum, with Medicare-covered dental requiring a $20 copay and no coinsurance. Preventive services are available with no copay and no coinsurance, while covered comprehensive services have no copay and 50% coinsurance; however, other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Peak Advantage Vista (PPO) with no copay, subject to prior authorization. Under this plan, Medicare Part B chemotherapy, radiation, and other Part B drugs carry no copay and coinsurance ranging from no coinsurance to 20%, while covered Part B insulin drugs require a $35 copay and no coinsurance 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 a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, subject to prior authorization. Diabetic supplies are not covered under this plan, and manufacturer limitations apply to durable medical equipment and diabetic services.
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 radiology services require a copayment starting at $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
Peak Advantage Vista (PPO) offers some covered services for Cardiac Rehabilitation Services with no copay and no coinsurance, requiring a referral. However, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Peak Advantage Vista (PPO) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and a 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) provides coverage for select other services, including acupuncture for a $25 copay and no coinsurance for 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.
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