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Peak Advantage Summit (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Peak Advantage Summit (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Peak Advantage Summit (PPO) in 2025, please refer to our full plan details page.
Peak Advantage Summit (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 Summit (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 Summit (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 Summit (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $16.00. 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 $9550.00 (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 $9550.00 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 Summit (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for each prescription, depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $4 copay at preferred pharmacies and a $20 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy (LIS), you will pay $2.40 for each prescription.
Additional Benefits
The Peak Advantage Summit (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0 to $250. Emergency services have a copay, and primary care visits have no copay. This plan includes coverage for preventive, hearing, vision, and dental services, each with specific copays, coinsurance, and annual limits. Other covered services include ambulance, transportation, home health, skilled nursing, and additional services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Peak Advantage Summit (PPO) plan. For Inpatient Hospital-Acute, you will pay a $800 copay per admission for days 1-60. Inpatient Hospital Psychiatric has a $400 copay for days 1-3, and no copay for days 4-90.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, with a copay between $0 and $250. Observation Services have a $200 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Peak Advantage Summit (PPO) plan, with a $250 copay for both ground and air ambulance services. The plan also covers transportation services to plan-approved health-related locations, with up to 36 one-way trips per year.
Emergency Services See details
Emergency Services are covered by the Peak Advantage Summit (PPO) plan. Emergency Services have a $90 copay and no coinsurance, while Urgently Needed Services have a $30 copay and no coinsurance. Worldwide Emergency Coverage has a $95 copay and no coinsurance, but Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Peak Advantage Summit (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, physician specialist services, physical therapy, and speech-language pathology services with a $20 copay, mental health specialty services with a $30 copay for individual and group sessions, podiatry services with a $20 copay, other health care professional services with a copay between $0 and $25, psychiatric services with a $30 copay for individual and group sessions, additional telehealth benefits, and opioid treatment program services with a $25 copay. Prior authorization is required for chiropractic services, physician specialist services, occupational therapy services, physical therapy and speech-language pathology services, and opioid treatment program services.
Preventive Services See details
The Peak Advantage Summit (PPO) plan covers preventive services, including Medicare-covered services with no copay, and additional services like a fitness benefit. However, annual physical exams, health education, in-home safety assessments, personal emergency response systems, and several other services are not covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year, as well as prescription hearing aids. Prescription hearing aids have a copay between $599 and $899, with a limit of one hearing aid per ear, per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services are covered by the Peak Advantage Summit (PPO) plan, including routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are limited to one per year, and there is a maximum benefit of $200 for both in-network and out-of-network services.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $3,500 per year for both in-network and out-of-network services. Oral exams, dental x-rays, cleaning, and fluoride treatment are covered, and restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and other Medicare Part B drugs with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Peak Advantage Summit (PPO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Peak Advantage Summit (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, but no copay, and requires authorization. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and no copay. Diabetic Equipment has a coinsurance, but the exact amount is not specified, and Diabetic Supplies are not covered, but Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $20, and Diagnostic Radiological Services have a maximum copay of $200. Therapeutic Radiological Services have a $50 copay, and Outpatient X-Ray Services have no copay. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Peak Advantage Summit (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Peak Advantage Summit (PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. A doctor referral is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Peak Advantage Summit (PPO) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Peak Advantage Summit (PPO) plan covers acupuncture with a $20 copay, and over-the-counter items with a maximum benefit coverage amount of $120 every three months. The plan also covers a meal benefit for chronic illnesses. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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