Jane Dotson
Peak Health is a health insurance company headquartered in Morgantown, West Virginia, that offers Medicare Advantage plans. It is owned by not-for-profit healthcare providers, which allows it to have a collaborative approach to insurance. Peak Health's Medicare Advantage plans are called Peak Advantage Vista and Peak Advantage Summit. These plans offer flexibility and allow users to access providers both in and out of the network without a referral. Medicaid, on the other hand, is a government-sponsored health insurance program for certain low-income individuals and families who meet eligibility requirements. In Colorado, for example, Health First Colorado is the state's Medicaid program, and individuals can apply and manage their accounts through Colorado PEAK.
| Characteristics | Values |
|---|---|
| Nature of Business | Health insurer and health insurance services company |
| Headquarters | Morgantown, West Virginia |
| Owner | Four not-for-profit health care providers: WVU Health System, Marshall Health, Mountain Health Network, and Valley Health |
| Mission | To make health care more accessible, understandable, and collaborative |
| Vision | To be an inclusive, provider-led health plan that helps residents of West Virginia and beyond live healthier and fuller lives |
| Unique Selling Point | The only West Virginia-based insurance company to offer Medicare Advantage plans created by two of the state's top health systems |
| Plans Offered | Medicare Advantage PPO plans (Peak Advantage Vista and Peak Advantage Summit) |
| Network | Thousands of West Virginia doctors, specialists, hospitals, and other medical professionals, including providers in the WVU Medicine and Marshall Health health systems |
| Pharmacy Options | Hundreds of pharmacies across the state, including national chains and local grocery stores |
| Medicaid Program | Not explicitly mentioned, but Peak Health offers plans for Medicare-eligible residents and those who qualify for Child Health Plan Plus (CHP+), a public low-cost health insurance program |
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What You'll Learn
- Peak Health is a health insurance company based in West Virginia
- It offers Medicare Advantage plans, including Peak Advantage Vista and Summit
- Medicare Advantage plans can be switched annually during the Election Period
- Medicaid recipients may still purchase private health insurance at full price
- Medicaid eligibility is determined by household size, income, and state residency
Peak Health is a health insurance company based in West Virginia
Peak Health is a health insurance company based in Morgantown, West Virginia. It is owned by three (according to some sources, four) not-for-profit healthcare providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health is dedicated to offering a new approach to healthcare that is designed for its communities and delivered by local providers. The company aims to improve access to healthcare and bring down healthcare costs and administration fees for patients and employers.
Peak Health offers Medicare Advantage plans created by two of the state's top health systems: WVU Medicine and Marshall Health. This partnership allows the company to offer a completely collaborative approach to health coverage that was created by and for West Virginians. Peak Health's Medicare Advantage plans include $0 premium plans, $0 medical and prescription drug deductibles, $0 primary care provider copays, up to a $525 flexible spending card, up to a $4,000 dental allowance, and vision, hearing, and fitness benefits.
Peak Health also provides managed care, TPA services, pharmacy benefit management, third-party administrator services, and medical benefits. The company has a members-only web portal called MyPeak, which offers online tools for managing benefits, viewing claim statements, and accessing important resources.
In addition to its insurance business, Peak Health has announced a partnership with Mylan Park, West Virginia's premier recreation, sport, health, and wellness complex. This partnership will allow Medicare-eligible residents to enroll in a plan that meets the needs of seniors in the state.
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It offers Medicare Advantage plans, including Peak Advantage Vista and Summit
Peak Health is a health insurance company based in Morgantown, West Virginia. It is owned by four non-profit healthcare providers: WVU Health System, Marshall Health, Mountain Health Network, and Valley Health. This collaborative structure is designed to improve health outcomes in West Virginia and beyond.
Peak Health offers Medicare Advantage plans, including Peak Advantage Vista and Summit. These plans are also referred to as "Part C" or "MA" plans and are another way to get your Medicare Part A and Part B coverage. Medicare Advantage plans are offered by Medicare-approved private companies that must follow rules set by Medicare. Peak Health is the only West Virginia-based insurance company to offer Medicare Advantage plans created by two of the state's top health systems.
Peak Advantage Vista and Summit are both Medicare Advantage PPO plans. This means that users have the flexibility to use providers both in and out of the network without a referral. This is in contrast to Medicare Advantage HMO plans, where, except for emergencies, users must use network providers and obtain a referral from their primary care doctor to see a specialist.
Medicare Advantage plans typically include drug coverage (Part D) and supplemental benefits like dental, vision, hearing, eyewear, and fitness. Many Medicare Advantage plans have a $0 monthly premium, and the Annual Election Period (AEP) allows users to switch between plans without needing to disenroll from their current plan.
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Medicare Advantage plans can be switched annually during the Election Period
Medicare Advantage Plans can be switched once a year during the Annual Election Period (AEP), also known as the Medicare Open Enrollment Period. This period runs from 15 October to 7 December. During the AEP, Medicare beneficiaries enrolled in Medicare Advantage can switch coverage to a different Medicare Advantage Plan.
The Annual Election Period is different from the Medicare Advantage Open Enrollment Period (MA-OEP). The MA-OEP is a three-month period, from 1 January to 31 March, during which you can switch from your current Medicare Advantage Plan (with or without drug coverage) to a different Medicare Advantage Plan (also with or without drug coverage). You can also switch from your existing Medicare Advantage Plan to Original Medicare and purchase a standalone plan.
The MA-OEP is an important window that allows you to review your coverage. If you are happy with your current plan, you can continue with it. However, if your circumstances have changed, you may want to re-assess whether a change is necessary. For example, if your costs have increased, or you see other Medicare Advantage Plans with additional benefits that are important to you.
It is important to note that there are also Special Enrollment Periods (SEPs) that allow you to change your health and/or drug coverage outside of normal enrollment periods. For instance, if you move to a new address that is not in your plan's service area, you can switch to a new Medicare Advantage Plan or Medicare drug plan. You can also choose to go back to Original Medicare.
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Medicaid recipients may still purchase private health insurance at full price
Medicaid is a federal-state collaboration that assists specific low-income persons, families, children, pregnant women, the elderly, and people with disabilities in covering medical expenses. Each state closely collaborates with its state Medicaid programme. Medicaid eligibility requirements vary by state, and applicants must typically meet income and resource criteria. Some states allow individuals to "spend down" their income to qualify for Medicaid.
While Medicaid provides comprehensive coverage, it may not cover all health services. Individuals with Medicaid can purchase private health insurance to supplement their coverage. However, it is important to note that Medicaid recipients who purchase private health insurance at full price will not qualify for financial assistance to reduce the cost of their plan. This means that they will have to pay the full price for their private health insurance plan.
For example, in Colorado, individuals who qualify for Health First Colorado (Medicaid) can still purchase a private health insurance plan at full price. Similarly, individuals who qualify for Child Health Plan Plus (CHP+), a low-cost public health insurance programme for certain children and pregnant women, may have to pay an annual enrolment fee and copays to their healthcare provider.
Medicaid programmes may directly pay for care or use private insurance companies to provide Medicaid coverage. Additionally, Medicaid may cover medical expenses incurred in the three months before enrolment, even if the individual was not yet enrolled in Medicaid at the time. Furthermore, individuals with both Medicare and full Medicaid coverage are considered "dually eligible," with Medicare paying for services first and Medicaid covering any remaining costs.
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Medicaid eligibility is determined by household size, income, and state residency
Medicaid is a federal-state program that provides health coverage to over 77.9 million Americans. It is the largest source of health coverage in the United States. To be eligible for Medicaid, individuals must meet specific financial and non-financial criteria.
Income eligibility for Medicaid is determined using the Modified Adjusted Gross Income (MAGI) methodology, which considers taxable income and tax filing relationships. MAGI rules do not consider an individual or family's assets. While MAGI rules are mandatory for all states, they only apply to certain eligibility categories, such as parents, caregiver relatives, children, pregnant women, and the adult expansion group.
In addition to financial criteria, non-financial eligibility criteria for Medicaid include age, pregnancy or parenting status, and citizenship. To be eligible, individuals must generally be residents of the state in which they are receiving Medicaid and must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents.
It is important to note that Medicaid eligibility requirements can vary by state, and some states have expanded their Medicaid programs to cover more individuals. Individuals can apply for Medicaid through the Health Insurance Marketplace or their state's website to determine their eligibility.
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Frequently asked questions
Peak Health is a health insurance company headquartered in Morgantown, West Virginia. It is owned by not-for-profit health care providers and offers Medicare Advantage plans.
No, Peak Health is a health insurance company that offers Medicare Advantage plans. Medicaid is a separate government-funded health insurance program for those who qualify.
To see if you qualify for Medicaid, you can visit your state or county's website or visit an Application Assistance Site in person. In Colorado, for example, you can check your eligibility for Health First Colorado (Colorado's Medicaid program) through the PEAK website or mobile app.
