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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. Additionally, this plan comes with a Part B Premium reduction of $0.70. You must continue to pay paying your reduced 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. During the initial coverage phase, you will pay a copay for your prescriptions, which varies depending on the drug tier and the pharmacy you use. 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 $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your Part D premium will be reduced to $2.40.
Additional Benefits
The Peak Advantage Summit (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services have copays depending on the service. Emergency services have a copay, and primary care, including specialist visits, has copays. Preventive services are covered with no copay, and the plan covers hearing, vision, and dental services. Additional benefits include ambulance services with a copay, home infusion, dialysis, medical equipment, and skilled nursing facility services with copays or coinsurance. Other covered services include acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage with the Peak Advantage Summit (PPO) plan includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $800 copay for days 1-60. For Inpatient Hospital Psychiatric, you will pay a $400 copay for days 1-3, and no copay for days 4-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Peak Advantage Summit (PPO) plan. Outpatient Hospital Services have a copay between $0 and $250, Observation Services have a $250 copay, Ambulatory Surgical Center (ASC) Services have no copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the Peak Advantage Summit (PPO) plan. There is no information about the cost of this service in the provided snippet.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and Air Ambulance Services have a $225 copay, and Transportation Services to a plan-approved health-related location are covered for up to 36 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services under the Peak Advantage Summit (PPO) plan include a $90 copay for emergency services and a $30 copay for urgently needed services, with no coinsurance. Worldwide Emergency Coverage has a $95 copay; however, 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 with a $20 copay, and mental health specialty services with a $30 copay for individual and group sessions. The plan also covers 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, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits, and opioid treatment program services with a $35 copay.
Preventive Services See details
The Peak Advantage Summit (PPO) plan covers Medicare-covered preventive services, with no copay. Additional preventive services like Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered. However, the plan does not cover annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids are partially covered, with a copay between $599 and $899, depending on the type. Inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services include routine eye exams, eyewear, and upgrades. The plan covers one routine eye exam per year, and has a maximum benefit of $200 for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered.
Dental Services See details
Dental Services are covered, with a maximum benefit of $4,000 per year for both in-network and out-of-network services. Oral exams are covered for up to two visits per year, while restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have a 50% coinsurance, and other services are covered as described in the details.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Peak Advantage Summit (PPO) plan, with a $35 copay for Medicare Part B Insulin Drugs; coinsurance may apply for all other services. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Peak Advantage Summit (PPO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices with a 20% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Peak Advantage Summit (PPO) plan. Diagnostic Procedures/Tests and Lab Services are not covered, while Diagnostic Radiological Services have a copay of at most $190, Therapeutic Radiological Services have a copay of at most $50, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Peak Advantage Summit (PPO) plan, with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Peak Advantage Summit (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Peak Advantage Summit (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays are not covered.
Other Services See details
Under the Peak Advantage Summit (PPO) plan, acupuncture is covered with a $20 copay and requires prior authorization, and over-the-counter items are covered up to $120 every three months. The plan also covers a meal benefit for chronic illnesses, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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