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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 drug coverage begins immediately. For Tier 1 preferred generics, there is 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 generics cost a $4 copay for a 1-month supply at preferred pharmacies and standard mail order, or $20 at standard pharmacies. Tier 3 preferred brand drugs require a $42 copay for a 1-month supply at preferred pharmacies and standard mail order, compared to $47 at standard pharmacies. Tier 4 non-preferred drugs carry a $95 copay at preferred pharmacies or standard mail order and $100 at standard pharmacies for a 1-month supply. Lastly, specialty 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 affordable coverage for core medical needs, featuring no copay and no coinsurance for primary care visits, telehealth, and preventive services. Specialist visits and routine eye or hearing exams require a low $20 copay with no coinsurance. For more intensive care, inpatient hospital stays have no coinsurance with copayments up to $800, while emergency room visits carry a $90 copay that is waived if you are admitted. This plan also provides strong supplemental benefits, including dental coverage up to a $4,000 annual limit with no copay for preventive care and 50% coinsurance for comprehensive services. Covered eyewear features no copay or coinsurance, while prescription hearing aids require copays ranging from $399 to $899 with no coinsurance. Additionally, members benefit from no copay for home health services and an over-the-counter item allowance of up to $120 every three months with no copay.
Inpatient Hospital See details
Peak Advantage Summit (PPO) partially covers inpatient acute and psychiatric hospital services with no coinsurance, requiring prior authorization and copayments of up to $800 per stay depending on the length of care. Additional hospital days, non-Medicare-covered stays, and room upgrades are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by Peak Advantage Summit (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Medicare-covered outpatient hospital services require a copay of $0 to $250, observation services carry a $250 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Peak Advantage Summit (PPO) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Peak Advantage Summit (PPO), though transportation is only partially covered because transportation to any health-related location is not covered. Ground and air ambulance services require a $225 copay and no coinsurance, while up to 36 one-way trips per year to plan-approved locations are offered with no copay and no coinsurance.
Emergency Services See details
Peak Advantage Summit (PPO) covers emergency services with a $90 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $30 copay, both with no coinsurance. Worldwide emergency services are partially covered with a $95 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Peak Advantage Summit (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist and therapy visits require a $20 copay and no coinsurance. Chiropractic services are partially covered, with other chiropractic services not covered, and require a $15 to $20 copay and no coinsurance. Other services like mental health, podiatry, and opioid treatment are covered with copays ranging from $20 to $35 and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Peak Advantage Summit (PPO) with no copay and no coinsurance for annual physicals, health education, memory fitness, kidney education, and select screenings. Uncovered sub-services include in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Peak Advantage Summit (PPO) partially covers hearing services, offering routine annual hearing exams and fittings for a $20 copay and no coinsurance. Prescription hearing aids require no coinsurance with copays ranging from $399 to $899 (limit of one per ear, per year), though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Peak Advantage Summit (PPO) vision services are partially covered, with routine eye exams requiring a $20 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contact lenses and eyeglasses, features no copay and no coinsurance, with no deductibles applying to any of these vision benefits.
Dental Services See details
Peak Advantage Summit (PPO) offers partially covered dental services up to a $4,000 annual limit for in- and out-of-network care, with a $20 copay and no coinsurance for Medicare-covered dental, no copay and no coinsurance for preventive care, and no copay with 50% coinsurance for comprehensive treatments. Specific services including other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Peak Advantage Summit (PPO) with no copay, while associated Medicare Part B chemotherapy and other drugs require ranging from no coinsurance to 20% coinsurance. Medicare Part B insulin is also covered, requiring a $35 copay and ranging from no coinsurance to 20% coinsurance.
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) provides partial coverage for medical equipment, offering no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are not covered under this plan, and prior authorization is required for all covered medical equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Peak Advantage Summit (PPO) with no coinsurance, though prior authorization is required. There is no copay for lab services, outpatient X-rays, and diagnostic radiological services, while diagnostic procedures and tests have a copay of $0 to $20, and therapeutic radiological services require a minimum $50 copay.
Home Health Services See details
Home Health Services are covered under the Peak Advantage Summit (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Peak Advantage Summit (PPO) covers some cardiac rehabilitation services with no copay and no coinsurance when a referral is obtained. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Peak Advantage Summit (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a three-day prior inpatient hospital stay. There is no copay for days 1 through 20, a $218 copay applies for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Peak Advantage Summit (PPO) partially covers other services, offering acupuncture with a $20 copay and no coinsurance for up to 20 treatments 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 under these benefits.
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