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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 2026, 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 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 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 $9000.00 (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 $9000.00 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) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies and through standard mail order, while standard pharmacies charge a $15 copay for a 1-month supply. Tier 2 generic medications cost a low $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, 1-month copays start at $42 at preferred pharmacies and standard mail order, while Tier 4 non-preferred drugs carry a $95 copay at these same locations. Using a standard pharmacy increases these 1-month copays to $47 for Tier 3 and $100 for Tier 4. Specialty tier drugs in Tier 5 require a 33% coinsurance for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The Peak Advantage Summit (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, telehealth services, and annual preventive exams. If you require specialist visits or therapy, you will pay a copay ranging from $20 to $35 with no coinsurance. Emergency room visits carry a $90 copay, while inpatient hospital stays require copayments up to $800 with no coinsurance. For additional health needs, the plan provides preventive dental care with no copay and comprehensive dental services up to a $3,500 annual limit with a 50% coinsurance. Vision and hearing routine exams require a $20 copay, which includes up to a $200 annual allowance for eyewear and prescription hearing aid copays starting at $399. Members also benefit from a quarterly over-the-counter allowance of $120 with no copay, and home health services are fully covered with no copay or coinsurance.
Inpatient Hospital See details
Peak Advantage Summit (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Medicare-covered acute stays require copayments up to $800, and psychiatric stays require copayments ranging from no copay to $800, while upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Peak Advantage Summit (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $250, observation services have a $250 copay per stay, and outpatient substance abuse sessions carry a $40 copay.
Partial Hospitalization See details
Peak Advantage Summit (PPO) covers partial hospitalization services with no copay and no coinsurance.
Ambulance and Transportation Services See details
Peak Advantage Summit (PPO) covers ground and air ambulance services with a $250 copay and no coinsurance per service. Transportation services are partially covered, offering up to 36 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Peak Advantage Summit (PPO) with a $90 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed services require a $30 copay and no coinsurance. Worldwide emergency services are partially covered with a $95 copay and no coinsurance for emergency coverage, but worldwide urgent care and worldwide emergency transportation are not covered.
Primary Care See details
Peak Advantage Summit (PPO) primary care benefits feature no copay and no coinsurance for primary care physician visits and telehealth services. Specialist visits, therapy, and mental health services are covered with no coinsurance and copays ranging from $20 to $35, though chiropractic care is only partially covered since other chiropractic services are not covered.
Preventive Services See details
Peak Advantage Summit (PPO) covers preventive services, including annual physical exams, kidney disease education, and memory fitness, with no copay and no coinsurance. This benefit is only partially covered, as additional services like in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Peak Advantage Summit (PPO) provides partially covered hearing services, featuring a $20 copay and no coinsurance for annual routine exams and fittings, and prescription hearing aid coverage with no coinsurance and copays ranging from $399 to $899. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision Services under the Peak Advantage Summit (PPO) are partially covered, featuring a $20 copay and no coinsurance for one routine annual eye exam, while other eye exam services are not covered. Eyewear, including contacts, lenses, frames, and upgrades, is covered with no copay and no coinsurance up to a maximum annual benefit of $200.
Dental Services See details
Peak Advantage Summit (PPO) offers partially covered dental services up to a $3,500 annual limit, featuring Medicare-covered dental for a $20 copay and no coinsurance, and preventive services with no copay and no coinsurance. Comprehensive services are available with no copay and 50% coinsurance, though other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Peak Advantage Summit (PPO) covers Home Infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs carry no copay and coinsurance ranging from no coinsurance up to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered under the Peak Advantage Summit (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Peak Advantage Summit (PPO) partially covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Prior authorization is required for these covered benefits, though diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Peak Advantage Summit (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Members pay no copay for lab services and outpatient X-rays, while diagnostic procedures range from a $0 to $20 copay, diagnostic radiology copays start at $0, and therapeutic radiology copays start at $50.
Home Health Services See details
Home Health Services are covered under the Peak Advantage Summit (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Peak Advantage Summit (PPO) provides Cardiac Rehabilitation Services with no copay and no coinsurance, though a referral is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Peak Advantage Summit (PPO) with no coinsurance, though prior authorization and a prior three-day inpatient hospital stay are required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage for additional days beyond the Medicare-covered limit.
Other Services See details
Other services under the Peak Advantage Summit (PPO) are partially covered, featuring acupuncture with a $20 copay and no coinsurance for up to 20 visits per year, and over-the-counter items with no copay and no coinsurance up to $120 every three months. Meal benefits, nicotine replacement therapy, and naloxone are not covered by this plan.
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