Quick answer
- Peru does not require travel insurance for US tourists.
- Machu Picchu sits at about 2,430 m (7,970 ft), but Cusco is higher, at roughly 3,400 m (11,150 ft), and classic treks such as the Inca Trail and Salkantay cross passes above 4,000 m (13,100 ft).
- Many policies limit trekking coverage by altitude. A basic plan may not cover you on the trail.
- Evacuation from the Andes or the Amazon to the US can cost from about $70,000 to more than $150,000, according to insurers.
- Many Machu Picchu tickets, trains and trek permits are non-refundable, which makes cancellation coverage valuable.
Peru combines high altitude, long distances, remote treks and non-refundable bookings. That makes it a destination where the details of a policy matter more than its price. This guide explains what to check before you book the Inca Trail, Salkantay or an Amazon lodge.
Is travel insurance required for Peru?
No. US citizens can visit Peru as tourists without a visa and without proof of insurance. Some trekking operators require clients to have insurance that covers the trek, and reputable Inca Trail outfitters often ask for proof.
Altitude: the clause that decides your claim
Altitude sickness is common in Cusco and the Sacred Valley, and it can become dangerous (high-altitude pulmonary or cerebral edema). Two policy details matter:
- Trekking altitude limits. Many plans cover hiking only up to a stated altitude, commonly somewhere between 2,000 m and 4,000 m, unless you buy an adventure or trekking upgrade. The Inca Trail’s Dead Woman’s Pass is about 4,215 m and Salkantay Pass about 4,600 m.
- Guided vs. unguided. Some policies cover high-altitude trekking only with a licensed guide, which the Inca Trail requires anyway.
Being in Cusco itself is generally covered as ordinary travel. The limits apply to trekking and climbing activities.
Medical evacuation in Peru
Lima has good private clinics. Cusco has private clinics used to treating tourists for altitude sickness and stomach illness, but serious cases often need transfer to Lima. From the Inca Trail, rescue involves carrying a patient down to a trailhead or rail line. From Amazon lodges near Puerto Maldonado or Iquitos, evacuation means a boat and a flight. Insurers estimate a medical evacuation from remote Peru to the US at roughly $70,000 to more than $150,000.
Recommended coverage for Peru
| Benefit | Suggested minimum |
|---|---|
| Emergency medical | $100,000 |
| Medical evacuation | $250,000 or more |
| Trekking or adventure coverage | Up to at least 4,700 m for Salkantay and the Inca Trail |
| Trip cancellation and interruption | Prepaid permits, trains, tours and flights |
| Trip delay | Strikes and road blockades can disrupt travel |
Non-refundable bookings
Inca Trail permits are limited, sell out months ahead and are tied to your passport. Machu Picchu entry tickets are timed, and train tickets to Aguas Calientes often have strict change rules. If illness, a family emergency or a covered travel delay stops you, cancellation and interruption coverage is what reimburses these costs. Protests and road blockades have disrupted travel in southern Peru in recent years; whether they are covered depends on the policy’s wording on civil unrest and strikes, so check it.
Other Peru-specific checks
- Amazon trips: confirm evacuation from remote lodges, and talk to a travel clinic about yellow fever and malaria prevention.
- Adventure activities: sandboarding in Huacachina, rafting near Cusco and mountain biking on the Inca Jungle Trek are often excluded from basic plans.
- Domestic flights: insure them too; they are a common source of missed connections.
Medicare and US plans in Peru
Original Medicare generally pays nothing in Peru. Medigap foreign travel benefits pay 80% after a $250 deductible, up to $50,000 lifetime, without evacuation. Older travelers with heart or lung conditions should talk to a doctor about altitude before booking and look for a policy with a pre-existing condition waiver.
Sources
- US Department of State, Peru country information.
- CDC Yellow Book, high-altitude travel and Peru destination page.
- American Visitor Insurance and VisitorsCoverage, Peru evacuation cost estimates and requirements.
- Peruvian Ministry of Culture, Machu Picchu and Inca Trail permit rules.
Frequently asked questions
Do I need travel insurance for Machu Picchu?
It is not legally required, but trekking operators may ask for it, and evacuation from the Andes is expensive. Make sure the policy covers trekking at the altitudes on your route.
Does travel insurance cover altitude sickness in Peru?
Usually yes as a medical emergency, but trekking above the policy’s altitude limit can be excluded. The Inca Trail and Salkantay routes cross passes above 4,000 m.
What altitude coverage do I need for the Salkantay trek?
Salkantay Pass is about 4,600 m, so look for trekking coverage up to at least 4,700 m or an adventure upgrade without a lower limit.