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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 $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) plan offers prescription drug coverage with a $0 drug deductible, meaning your benefits start immediately. For Tier 1 preferred generic drugs, there is no copay when using a preferred pharmacy or standard mail order. Tier 2 generic drugs are also highly affordable, costing a low $4 copay for a one-month supply at preferred pharmacies and standard mail order. For brand-name and specialty medications, copays and coinsurance vary depending on the drug tier and pharmacy type. Tier 3 preferred brand drugs carry a $42 copay at preferred pharmacies, while Tier 4 non-preferred drugs cost $95 for a one-month supply. Specialty drugs in Tier 5 require a 33% coinsurance at both preferred and standard pharmacies.
Additional Benefits
The Peak Advantage Summit (PPO) offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, telehealth, and routine preventive care. Specialist visits, physical therapy, routine eye exams, and routine hearing tests are highly affordable with a $20 copay and no coinsurance. Inpatient hospital stays feature no coinsurance and copays up to $800, while emergency room visits require a $90 copay that is waived if you are admitted. Beyond medical services, the plan provides robust dental benefits with no copay for preventive care and a 50% coinsurance for comprehensive care up to a $3,500 annual limit. Members also benefit from no-copay eyewear, affordable prescription hearing aids, and a quarterly $120 allowance for over-the-counter items. Additionally, the plan covers up to 36 one-way transportation trips per year to approved locations and home health services with no copay.
Inpatient Hospital See details
Peak Advantage Summit (PPO) partially covers inpatient hospital services with no coinsurance and copayments up to $800 per stay, requiring prior authorization for both acute and psychiatric care. Additional days, upgrades, and non-Medicare-covered stays for inpatient acute and psychiatric hospitalizations are not covered.
Outpatient Services See details
Outpatient services are covered by Peak Advantage Summit (PPO) with no coinsurance, featuring a $0 to $250 copay for outpatient hospital services and a $250 copay per stay for observation services. Ambulatory surgical center and blood services are available with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay with no coinsurance.
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 ambulance services with a $250 copay and no coinsurance for both ground and air transport, which require prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 36 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Peak Advantage Summit (PPO) covers emergency services with a $90 copay—which is waived if admitted to the hospital within 24 hours—and urgently needed services with a $30 copay, both featuring 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 visits, physical therapy, occupational therapy, and podiatry require a $20 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have copays ranging from $30 to $35 with no coinsurance, though chiropractic care is only partially covered as other chiropractic services are not covered.
Preventive Services See details
Peak Advantage Summit (PPO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay or coinsurance, but do not cover in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home/bathroom safety modifications, and counseling.
Hearing Services See details
Peak Advantage Summit (PPO) partially covers hearing services, offering one routine exam and fitting annually for a $20 copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $399 to $899 and no coinsurance, though OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
Peak Advantage Summit (PPO) vision services are partially covered, featuring a $20 copay and no coinsurance for annual routine eye exams, while other eye exam services are not covered. Eyewear, including contact lenses and eyeglasses, is covered with no copay and no coinsurance, with no deductibles applying to these benefits.
Dental Services See details
Peak Advantage Summit (PPO) provides partially covered dental services with an annual maximum of $3,500, offering preventive services with no copay and no coinsurance, and comprehensive services with no copay and 50% coinsurance. Medicare-covered dental has a $20 copay and no coinsurance, while other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics 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 and step therapy. Covered Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Peak Advantage Summit (PPO) 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 services, but 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. Lab services and outpatient X-rays have no copay, while diagnostic procedures carry a $0 to $20 copay, diagnostic radiology starts at a $0 copay, and therapeutic radiology requires a minimum copay of $50.
Home Health Services See details
Peak Advantage Summit (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
Peak Advantage Summit (PPO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, although a referral is required. However, 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) care is covered by Peak Advantage Summit (PPO) with no coinsurance, requiring prior authorization and a 3-day inpatient hospital stay. 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
Peak Advantage Summit (PPO) covers acupuncture with a $20 copay, no coinsurance, and a limit of 20 treatments per year with prior authorization. Over-the-counter items are also covered with no copay and no coinsurance up to $120 every three months, while meal benefits, nicotine replacement therapy, and naloxone are not covered.
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