Peak Advantage Summit (PPO)
Available to residents of Monongalia County, WV for 2027. Contract H8947, plan 002, segment 1.
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- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Monongalia County
- Plan website
- Browse the Peak Advantage Summit (PPO) formulary
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
Plan details
| Monthly premium (Part C + D) | $25.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $25.00? |
| Monthly premium with full Extra Help (LIS) | $12.20? |
| Part B premium reduction (giveback) | None |
| In-network out-of-pocket maximum | $6,750.00? |
| In- and out-of-network out-of-pocket maximum | $10,100.00 |
| Drug deductible | $0.00 |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | PPO? |
| Contract / plan | H8947-002-1 |
| Offered by | Peak Health |
| Parent organization | West Virginia United Health System, Inc. |
| Formulary tiers | 5 |
| Formulary exception tier | 4? |
| Pharmacy search | medicare.peakhealth.org |
| Member services | (855)847-1026TTY 711 |
CMS star ratings
- Overall
- 5 out of 5 stars for Overall
- Health plan (Part C)
- 5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 4.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H8947 shares this rating.
Plan health benefits
| Service | In-network | Out-of-network? |
|---|---|---|
| Doctor visits | ||
| Primary care doctor | $0 copay | 35% coinsurance |
| Specialist | $20 copay(authorization required) | $30 copay |
| Other health care professional | $0–$25 copay(authorization required) | 35% coinsurance |
| Additional telehealth services | $0 copay | — |
| Preventive care | ||
| Medicare-covered preventive services | $0 copay | 35% coinsurance |
| Annual physical exam | $0 copay | 35% coinsurance |
| Kidney disease education | $0 copay | 35% coinsurance |
| Glaucoma screening | $0 copay | 35% coinsurance |
| Diabetes self-management training | $0 copay | 35% coinsurance |
| Diagnostic tests, labs and imaging | ||
| Diagnostic tests and procedures | $0–$20 copay(authorization required) | 35% coinsurance |
| Lab services | $0–$20 copay(authorization required) | 35% coinsurance |
| Diagnostic radiology (e.g. MRI, CT) | $0–$200 copay(authorization required) | 35% coinsurance |
| Therapeutic radiology | $50 copay(authorization required) | 35% coinsurance |
| Outpatient x-rays | $0–$20 copay(authorization required) | 35% coinsurance |
| Emergency and urgent care | ||
| Emergency room | $115 copay | — |
| Urgent care | $40 copay | — |
| Worldwide emergency coverage | $115 copay | — |
| Worldwide urgent care | Not covered | — |
| Worldwide emergency transportation | Not covered | — |
| Hospital care | ||
| Inpatient hospital stay | $495 per stay(authorization required) | 35% coinsurance per stay |
| Outpatient hospital services | $0–$250 copay(authorization required) | 35% coinsurance |
| Outpatient observation | $250 copay | 35% coinsurance |
| Ambulatory surgical center | $0–$200 copay(authorization required) | 35% coinsurance |
| Outpatient blood services | $0 copay(authorization required) | 35% coinsurance |
| Skilled nursing and home health | ||
| Skilled nursing facility | $0 per day for days 1–20; $218 per day for days 21–100(authorization required) | 35% coinsurance per stay |
| Home health care | $0 copay(authorization required) | 35% coinsurance |
| Kidney dialysis | 20% coinsurance | 35% coinsurance |
| Rehabilitation | ||
| Occupational therapy | $20 copay(authorization required) | 35% coinsurance |
| Physical therapy and speech-language therapy | $20 copay(authorization required) | 35% coinsurance |
| Cardiac rehabilitation | $0 copay(referral required) | 35% coinsurance |
| Pulmonary rehabilitation | $0 copay(referral required) | 35% coinsurance |
| Mental health and substance use | ||
| Inpatient psychiatric hospital stay | $425 per day for days 1–3; $0 per day for days 4–90(authorization required) | 35% coinsurance per stay |
| Outpatient mental health, individual session | $30 copay | 35% coinsurance |
| Outpatient mental health, group session | $30 copay | 35% coinsurance |
| Psychiatrist, individual session | $30 copay | 35% coinsurance |
| Psychiatrist, group session | $30 copay | 35% coinsurance |
| Partial hospitalization | $0 copay | 35% coinsurance |
| Intensive outpatient program | $0 copay | 35% coinsurance |
| Outpatient substance use, individual session | $40 copay | 35% coinsurance |
| Outpatient substance use, group session | $40 copay | 35% coinsurance |
| Opioid treatment program | $35 copay(authorization required) | 35% coinsurance |
| Ambulance and transportation | ||
| Ground ambulance | $250 copay(authorization required) | 35% coinsurance |
| Air ambulance | $250 copay(authorization required) | 35% coinsurance |
| Transportation to plan-approved locations | $0 copay(authorization required, limits apply) | 35% coinsurance |
| Medical equipment and supplies | ||
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) | 35% coinsurance |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) | 35% coinsurance |
| Medical supplies | 20% coinsurance(authorization required) | 35% coinsurance |
| Diabetes supplies | $0 copay(authorization required) | 35% coinsurance |
| Diabetic therapeutic shoes or inserts | 20% coinsurance(authorization required) | 35% coinsurance |
| Chiropractic, acupuncture and foot care | ||
| Chiropractic (Medicare-covered) | $15 copay(authorization required) | 35% coinsurance |
| Routine chiropractic care | $20 copay(authorization required, limits apply) | 35% coinsurance |
| Acupuncture | $20 copay(authorization required, limits apply) | 35% coinsurance |
| Foot exams and treatment (Medicare-covered) | $20 copay(authorization required) | 35% coinsurance |
| Routine foot care | $20 copay(authorization required, limits apply) | 35% coinsurance |
| Dental? | ||
| Medicare-covered dental services | $20 copay | 35% coinsurance |
| Preventive dental plan limit | $3,500 plan limit every year | — |
| Oral exams | $0 copay(limits apply) | $0 copay |
| Cleanings | $0 copay(limits apply) | $0 copay |
| Fluoride treatment | $0 copay(limits apply) | $0 copay |
| Dental x-rays | $0 copay(limits apply) | $0 copay |
| Other diagnostic dental services | Not covered | — |
| Other preventive dental services | Not covered | — |
| Restorative services (fillings, crowns) | 50% coinsurance(limits apply) | 50% coinsurance |
| Endodontics (root canals) | 50% coinsurance(limits apply) | 50% coinsurance |
| Periodontics (gum disease) | 50% coinsurance(limits apply) | 50% coinsurance |
| Dentures and other removable prosthodontics | 50% coinsurance(limits apply) | 50% coinsurance |
| Maxillofacial prosthetics | Not covered | — |
| Implants | Not covered | — |
| Bridges and other fixed prosthodontics | 50% coinsurance(limits apply) | 50% coinsurance |
| Oral and maxillofacial surgery | 50% coinsurance(limits apply) | 50% coinsurance |
| Orthodontics | Not covered | — |
| Adjunctive general services | 50% coinsurance(limits apply) | 50% coinsurance |
| Vision? | ||
| Eye exam (Medicare-covered) | $20 copay(limits apply) | 35% coinsurance |
| Routine eye exam | $0 copay(limits apply) | 35% coinsurance |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(limits apply) | 35% coinsurance |
| Contact lenses | $0 copay(limits apply) | 35% coinsurance |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) | 35% coinsurance |
| Eyeglass lenses | $0 copay(limits apply) | 35% coinsurance |
| Eyeglass frames | $0 copay(limits apply) | 35% coinsurance |
| Eyewear upgrades | $0 copay(limits apply) | 35% coinsurance |
| Hearing? | ||
| Hearing exam (Medicare-covered) | $20 copay | 35% coinsurance |
| Routine hearing exam | $0 copay(limits apply) | 35% coinsurance |
| Hearing aid fitting and evaluation | $0 copay(limits apply) | 35% coinsurance |
| Hearing aids (all types) | $399–$899 copay(limits apply) | 35% coinsurance |
| Hearing aids, inner ear | Not covered | — |
| Hearing aids, outer ear | Not covered | — |
| Hearing aids, over the ear | Not covered | — |
| Medicare Part B drugs | ||
| Part B insulin | 0%–20% coinsurance(authorization required, step therapy may apply) | 35% coinsurance |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) | 35% coinsurance |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) | 35% coinsurance |
| Other extra benefits? | ||
| Over-the-counter (OTC) allowance | $70 allowance every three months | — |
| Meals after a hospital stay or for a chronic condition | Not covered | — |
| Fitness benefit | $0 copay | $0 copay |
| Health education | $0 copay | $0 copay |
| Nutritional / dietary benefit | Not covered | — |
| Extra smoking and tobacco cessation counseling | Not covered | — |
| Enhanced disease management | Not covered | — |
| Telemonitoring | Not covered | — |
| Remote access technologies (web/phone, nurse line) | Not covered | — |
| Home and bathroom safety devices | Not covered | — |
| Counseling services | Not covered | — |
| In-home safety assessment | Not covered | — |
| Personal emergency response system (PERS) | Not covered | — |
| Medical nutrition therapy | Not covered | — |
| Post-discharge in-home medication reconciliation | Not covered | — |
| Re-admission prevention | Not covered | — |
| Wigs for hair loss from chemotherapy | Not covered | — |
| Weight management programs | Not covered | — |
| Alternative therapies | Not covered | — |
| Therapeutic massage | Not covered | — |
| Adult day health services | Not covered | — |
| Home-based palliative care | Not covered | — |
| In-home support services | Not covered | — |
| Support for caregivers | Not covered | — |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2027). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed; an out-of-network dash means the plan files no separate out-of-network cost for that service. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 · Preferred Generic | $0.00 |
| Tier 2 · Generic | $4.00 |
| Tier 3 · Preferred Brand | 25% |
| Tier 4 · Non-Preferred Drug | 25% |
| Tier 5 · Specialty Tier | 33% |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $4.00 | $4.00 | $4.00 | $12.00 | $12.00 | $12.00 |
| Tier 3: Preferred Brand | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 4: Non-Preferred Drug | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 5: Specialty Tier | 33% | 33% | n/a | n/a | n/a | n/a |
These are the initial coverage phase amounts, as the plan filed them in its benefit package. The deductible and post-threshold phases are not stated per tier in that filing, so they are not shown here rather than being inferred; the plan's annual out-of-pocket threshold is $2,400.00.
Star rating measures
| Measure | 2027 | 2026 |
|---|---|---|
| Staying Healthy: Screenings, Tests and Vaccines | ||
| Colorectal Cancer Screening · C02 | 4 out of 5 stars for Colorectal Cancer Screening | not enough data |
| Annual Flu Vaccine · C03 | 4 out of 5 stars for Annual Flu Vaccine | 4 out of 5 stars for Annual Flu Vaccine |
| Monitoring Physical Activity · C06 | 2 out of 5 stars for Monitoring Physical Activity | too new |
| Managing Chronic (Long Term) Conditions | ||
| Diabetes Care – Eye Exam · C11 | 4 out of 5 stars for Diabetes Care – Eye Exam | 3 out of 5 stars for Diabetes Care – Eye Exam |
| Diabetes Care – Blood Sugar Controlled · C12 | 5 out of 5 stars for Diabetes Care – Blood Sugar Controlled | 5 out of 5 stars for Diabetes Care – Blood Sugar Controlled |
| Kidney Health Evaluation for Patients with Diabetes · C13 | 4 out of 5 stars for Kidney Health Evaluation for Patients with Diabetes | 5 out of 5 stars for Kidney Health Evaluation for Patients with Diabetes |
| Controlling High Blood Pressure · C14 | 2 out of 5 stars for Controlling High Blood Pressure | 2 out of 5 stars for Controlling High Blood Pressure |
| Reducing the Risk of Falling · C15 | 3 out of 5 stars for Reducing the Risk of Falling | too new |
| Improving Bladder Control · C16 | 3 out of 5 stars for Improving Bladder Control | too new |
| Plan All-Cause Readmissions · C17 | 4 out of 5 stars for Plan All-Cause Readmissions | no data |
| Statin Therapy for Patients with Cardiovascular Disease · C18 | 4 out of 5 stars for Statin Therapy for Patients with Cardiovascular Disease | not enough data |
| Transitions of Care · C19 | 5 out of 5 stars for Transitions of Care | 4 out of 5 stars for Transitions of Care |
| Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions · C20 | 5 out of 5 stars for Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions | not enough data |
| Member Experience with Health Plan | ||
| Getting Needed Care · C21 | 5 out of 5 stars for Getting Needed Care | 5 out of 5 stars for Getting Needed Care |
| Getting Appointments and Care Quickly · C22 | 5 out of 5 stars for Getting Appointments and Care Quickly | 5 out of 5 stars for Getting Appointments and Care Quickly |
| Customer Service · C23 | 5 out of 5 stars for Customer Service | 5 out of 5 stars for Customer Service |
| Rating of Health Care Quality · C24 | 5 out of 5 stars for Rating of Health Care Quality | 5 out of 5 stars for Rating of Health Care Quality |
| Rating of Health Plan · C25 | 5 out of 5 stars for Rating of Health Plan | 5 out of 5 stars for Rating of Health Plan |
| Care Coordination · C26 | 5 out of 5 stars for Care Coordination | 5 out of 5 stars for Care Coordination |
| Member Complaints and Changes in the Health Plan's Performance | ||
| Complaints about the Health Plan · C27 | 5 out of 5 stars for Complaints about the Health Plan | 3 out of 5 stars for Complaints about the Health Plan |
| Members Choosing to Leave the Plan · C28 | 5 out of 5 stars for Members Choosing to Leave the Plan | 4 out of 5 stars for Members Choosing to Leave the Plan |
| Health Plan Quality Improvement · C29 | 5 out of 5 stars for Health Plan Quality Improvement | not enough data |
| Health Plan Customer Service | ||
| Plan Makes Timely Decisions about Appeals · C30 | 5 out of 5 stars for Plan Makes Timely Decisions about Appeals | 2 out of 5 stars for Plan Makes Timely Decisions about Appeals |
| Reviewing Appeals Decisions · C31 | 5 out of 5 stars for Reviewing Appeals Decisions | 2 out of 5 stars for Reviewing Appeals Decisions |
| Call Center – Foreign Language Interpreter and TTY Availability · C32 | 5 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 3 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD1: Drug Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · D01 | 3 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 3 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD2: Member Complaints and Changes in the Drug Plan’s Performance | ||
| Complaints about the Drug Plan · D02 | 5 out of 5 stars for Complaints about the Drug Plan | 3 out of 5 stars for Complaints about the Drug Plan |
| Members Choosing to Leave the Plan · D03 | 5 out of 5 stars for Members Choosing to Leave the Plan | 4 out of 5 stars for Members Choosing to Leave the Plan |
| Drug Plan Quality Improvement · D04 | 5 out of 5 stars for Drug Plan Quality Improvement | not enough data |
| DD3: Member Experience with the Drug Plan | ||
| Rating of Drug Plan · D05 | 5 out of 5 stars for Rating of Drug Plan | 5 out of 5 stars for Rating of Drug Plan |
| Getting Needed Prescription Drugs · D06 | 5 out of 5 stars for Getting Needed Prescription Drugs | 5 out of 5 stars for Getting Needed Prescription Drugs |
| DD4: Drug Safety and Accuracy of Drug Pricing | ||
| MPF Price Accuracy · D07 | 5 out of 5 stars for MPF Price Accuracy | 5 out of 5 stars for MPF Price Accuracy |
| Medication Adherence for Diabetes Medications · D08 | 4 out of 5 stars for Medication Adherence for Diabetes Medications | 3 out of 5 stars for Medication Adherence for Diabetes Medications |
| Medication Adherence for Hypertension (RAS antagonists) · D09 | 4 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists) | 3 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists) |
| Medication Adherence for Cholesterol (Statins) · D10 | 4 out of 5 stars for Medication Adherence for Cholesterol (Statins) | 2 out of 5 stars for Medication Adherence for Cholesterol (Statins) |
| Statin Use in Persons with Diabetes (SUPD) · D11 | 2 out of 5 stars for Statin Use in Persons with Diabetes (SUPD) | 1 out of 5 stars for Statin Use in Persons with Diabetes (SUPD) |
| Concurrent Use of Opioids and Benzodiazepines (COB) · D12 | 4 out of 5 stars for Concurrent Use of Opioids and Benzodiazepines (COB) | new measure |
| Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) · D13 | 3 out of 5 stars for Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) | new measure |
Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H8947 shares it.
Also available in 43 other WV counties
Benefits in plain text
Peak Advantage Summit (PPO) (H8947-002-1) is a 2027 PPO Medicare Advantage plan offered by Peak Health, available to residents of Monongalia County, WV.
The monthly premium is $25.00.
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $12.20.
Its in-network out-of-pocket maximum is $6,750.00.
The combined in- and out-of-network out-of-pocket maximum is $10,100.00.
The drug deductible is $0.00.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1 (Preferred Generic): $0.00; tier 2 (Generic): $4.00; tier 3 (Preferred Brand): 25%; tier 4 (Non-Preferred Drug): 25%; tier 5 (Specialty Tier): 33%.
CMS gives the plan's contract (H8947) an overall rating of 5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.