Before you start

Carné de extranjería
An employment contract, for EsSalud through an employer
Confirmation that your employer has declared you on its payroll filings
Travel or private cover for the first weeks, before EsSalud entitlement begins

Step-by-step

1
Acclimatise deliberately for the first three days
Arriving from sea level, rest, hydrate heavily, avoid alcohol and eat lightly. Coca tea helps and is entirely legal here. Do not schedule work, hikes or heavy lifting on day one — this is the single most-ignored piece of advice in the city.
In personWho: YouFirst 72 hours
2
Know the warning signs that mean descend, not rest
Ordinary soroche is headache, breathlessness and poor sleep. Confusion, an inability to walk in a straight line, or breathlessness at rest with a persistent cough are different and are medical emergencies. The treatment is oxygen and descent — the Sacred Valley at 2,800 metres or a flight to Lima. Know this before you need it.
In personWho: You
3
Confirm your employer has registered you with EsSalud
Entitlement follows the employer's monthly payroll declaration, not the signature on your contract. Ask for confirmation that you appear in the state payroll system, because a gap is invisible until you need care.
Via employerWho: Your employerFirst month
4
Ask whether an EPS is on offer
An EPS redirects part of the employer's EsSalud contribution into a private plan with far shorter waits. Larger tourism and hospitality employers sometimes offer one and rarely mention it. Ask which clinics the plan covers in Cusco specifically.
Via employerWho: You
5
Register with a clinic used to altitude cases
Cusco's private clinics see altitude illness constantly and keep oxygen on hand. Find yours, save the number, and know how you would get there at three in the morning from where you live — the steep streets of San Blas are a factor in that answer.
In personWho: You
6
Arrange cover yourself if you are self-employed or seasonal
Independent workers can join EsSalud as independent contributors or buy private insurance. Cusco's large population of freelance guides and remote workers frequently carries nothing at all, which is a bad bet in a city with mountain roads and thin air.
OnlineWho: You

Documents you’ll need

Carné de extranjería
Employment contract
EsSalud registration confirmation
EPS or private policy details
Yellow-fever vaccination record, if you will travel to the jungle side of the region

Things most newcomers don’t know

The definitive treatment for serious altitude illness is descent, and that shapes where you should live.

Oxygen and medication buy time; going down fixes it. From Cusco that means the Sacred Valley at around 2,800 metres, forty-five minutes away, or a flight to Lima at sea level. Anyone with a cardiac or pulmonary condition, and anyone who has reacted badly to altitude before, should factor this into where in the region they live — the valley is meaningfully easier on the body and is why a large share of long-term foreign residents end up there.

Source: community-reported; altitude medicine guidance

Water boils at about 88 °C here, so the sea-level boiling rule does not sterilise properly.

Reduced air pressure lowers the boiling point substantially at 3,400 metres. Public-health guidance for altitudes above 2,000 metres is to hold water at a rolling boil for three minutes rather than the one minute that suffices at sea level. Residents who boil briefly out of habit, or who use a kettle that switches off at the boil, are not achieving what they think. A filter rated for microbiological removal is the simpler answer.

Source: public-health guidance on water treatment at altitude

Cusco's seasonal economy produces annual gaps in health cover, and nobody plans for them.

EsSalud entitlement depends on being on an employer's payroll, and Cusco's tourism employers hire in April and shed staff in November. That means a substantial part of the working population is uninsured for several months every year, usually the months they are least able to pay for private care. Switching to independent EsSalud contributions or a cheap private policy across the low season is the fix, and almost nobody does it.

Source: EsSalud; community-reported

The sun at 3,400 metres near the tropics does damage on days that feel cold.

Ultraviolet intensity rises with altitude and Cusco sits at 13 degrees south, so UV levels here are among the highest of any inhabited city. The dry season brings bright sun with air temperatures near freezing at dawn, which is exactly the combination that produces burns in people who have decided it is too cold to need sunscreen. Daily sun protection is a local norm and it is not vanity.

Source: community-reported

Common mistakes to avoid

Scheduling work or a hike in your first 24 hours at 3,400 metres.
Treating confusion or breathlessness at rest as ordinary soroche instead of an emergency.
Boiling water for thirty seconds as you would at sea level.
Going uninsured through the low season when your employer's payroll drops you.
Skipping sunscreen because the air is cold.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.