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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 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 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 $20.00. 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 $8800.00 (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 $8800.00 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 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 or through standard mail order, while standard pharmacies charge a $15 copay for a 1-month supply. Tier 2 generic drugs cost a $4 copay for a 1-month supply at preferred pharmacies and standard mail order, compared to $20 at standard pharmacies. Tier 3 preferred brand drugs require a $42 copay for a 1-month supply at preferred pharmacies or standard mail order, which increases to $47 at standard pharmacies. Tier 4 non-preferred drugs carry a $95 copay at preferred pharmacies and standard mail order, or $100 at standard pharmacies for a 1-month supply. For Tier 5 specialty drugs, you will pay a 33% coinsurance for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The Peak Advantage Summit (PPO) plan offers robust healthcare coverage with no copay and no coinsurance for primary care, telehealth, and preventive services. For specialized care, members pay a $20 copay for specialist visits and physical therapy, while emergency room visits require a $100 copay with no coinsurance. Inpatient hospital stays feature an $800 copay for days 1 through 60, and skilled nursing care is available with no copay for the first 20 days. Supplemental benefits include comprehensive dental services up to a $5,000 annual limit with 50% coinsurance, alongside routine dental care with no copay. Vision and hearing services require a $20 copay for routine exams, which includes up to $350 annually for eyewear with no copay and affordable copays for prescription hearing aids. Additionally, the plan provides up to 36 one-way transportation trips per year and a $100 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Peak Advantage Summit (PPO) inpatient hospital services are partially covered with no coinsurance, though prior authorization is required for all stays. Acute care stays require an $800 copay for days 1 through 60, while psychiatric stays have copays up to $800 for days 1 through 60 and no copay for days 4 through 90. Additional hospital days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Peak Advantage Summit (PPO) are covered with no coinsurance, featuring a $0 to $200 copay for outpatient hospital services and a $200 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while outpatient substance abuse individual and group sessions have a $40 copay and no coinsurance.
Partial Hospitalization See details
Peak Advantage Summit (PPO) covers partial hospitalization services with no copay and no coinsurance. This benefit ensures you can access structured outpatient psychiatric care with zero out-of-pocket costs.
Ambulance and Transportation Services See details
Peak Advantage Summit (PPO) provides partially covered ambulance and transportation services, though transportation to any health-related location is not covered. Medicare-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 $100 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, but worldwide urgent coverage 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 provider and telehealth visits, while specialist, physical therapy, and occupational therapy services require a $20 copay and no coinsurance. Chiropractic services are partially covered with a $15 to $20 copay and no coinsurance, excluding other chiropractic services, while mental health, psychiatric, and podiatry services have copays ranging from $20 to $30 with no coinsurance.
Preventive Services See details
Peak Advantage Summit (PPO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay or coinsurance, but sub-services like in-home safety assessments, medical nutrition therapy, and personal emergency response systems are not covered.
Hearing Services See details
Peak Advantage Summit (PPO) covers annual routine hearing exams and fittings for a $20 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $899 (limited to one per ear yearly), while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Peak Advantage Summit (PPO) covers vision services with a $20 copay and no coinsurance for one routine eye exam per year, though other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is covered with no copay and no coinsurance, up to a combined maximum benefit of $350 per year for both exams and eyewear.
Dental Services See details
Peak Advantage Summit (PPO) offers partially covered dental services up to a $5,000 annual maximum, with a $20 copay and no coinsurance for Medicare-covered dental. Preventive care features no copay and no coinsurance, while covered comprehensive services require no copay and 50% coinsurance. Orthodontics, implants, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Peak Advantage Summit (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs require no copay and carry a coinsurance ranging from no coinsurance up to 20%, while Part B insulin has a $35 copay and the same coinsurance range.
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, prosthetic devices, medical supplies, and diabetic therapeutic shoes. Prior authorization is required for these benefits, and diabetic supplies are not covered under this plan.
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 for all services. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests require a copay of $0 to $20, diagnostic radiology has a minimum $0 copay, and therapeutic radiology has a minimum $50 copay.
Home Health Services See details
Peak Advantage Summit (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Peak Advantage Summit (PPO) technically offers Cardiac Rehabilitation Services with no copay and no coinsurance, but these services are not covered in practice. All associated sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by the Peak Advantage Summit (PPO) with no coinsurance, though prior authorization and a three-day inpatient hospital stay are required. Patients pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the Medicare limit are not covered.
Other Services See details
Peak Advantage Summit (PPO) covers 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 $100 every three months. Meal benefits, nicotine replacement therapy, and naloxone are not covered under these services.
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