Does OHIP Cover Dermatology? (2024 Guide)

Wondering if OHIP covers your dermatology appointment? In Ontario, the Ontario Health Insurance Plan (OHIP) covers medically necessary dermatology services, but not cosmetic treatments like Botox or mole removal.

This guide will walk you through everything you need to know about OHIP's dermatology coverage—what's included, what's not, and how much it costs to see a dermatologist.

Are dermatologists covered by OHIP in Ontario?

Yes, dermatology consultations are covered by the Ontario Health Insurance Plan (OHIP) if they are medically necessary. Anyone needing expert care for skin, hair, or nails can see a dermatologist at no cost under OHIP, but there are specific conditions for coverage.

1. Referral Required for OHIP Coverage: You must get a referral from a family doctor or nurse practitioner for a general dermatology appointment to be covered.
2. Free First and Follow-up Visits: Both your initial consultation and follow-up visits are covered under OHIP if referred by a doctor.
3. OHIP Covers Medically Necessary Treatments Only: Most dermatology procedures are covered only if they are deemed medically necessary. Cosmetic or elective treatments—like mole removal for aesthetic reasons—are not included.
4. Elective Treatments and Their Costs: Your OHIP-covered dermatologist will explain what is considered elective and how much these procedures will cost if you choose to have them.
5. OHIP Coverage Determined by the Ministry of Health: The Ministry of Health sets the list of covered procedures—not your doctor or dermatologist. However, your dermatologist will help you understand what’s covered based on your medical needs.

OHIP-Covered and Non-Covered Dermatology Services

OHIP-covered procedures	Not covered by OHIP
Skin cancer treatment	Earlobe repair
Suspicious mole examination	Skin tag removal
Medically necessary acne consultation	Eyelid xanthelasma removal
Eczema treatment	Lipomas removal
Wart removal (if affecting mobility)	Non-suspicious mole removal
Harmful wart removal	Botox or fillers for wrinkles
Skin screening (with referral)	Laser treatments for scars
Medically required cyst treatment	Spider vein treatment

Note that sometimes the location of a lesion is relevant to whether it is OHIP-covered. For example, liquid CO2 treatment for the removal of a foot wart is covered as it affects your ability to walk. A wart on the hand, however, is most likely not covered.

Although OHIP covers dermatological appointments and medically necessary treatments, any medications you might need are not insured. Some public medication programs cover a list of medications. OHIP+ for patients under 25 years old, the Ontario Drug Benefit (ODB) and the Ontario Disability and Support Program (ODSP) are a few examples of such programs.

If you don't qualify for the above programs and need to access dermatology services, you can explore private health insurance policies that offer extensive coverage. Use our free tool below to compare personalized health insurance quotes from Canada's best providers in seconds.

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How to see a dermatologist in Ontario? Step-by-Step Guide

If you need to see a dermatologist in Ontario, the process will depend on whether your concern is medical or cosmetic. Here's how to navigate the system:

OHIP-Covered Dermatology (Medical Needs)

For medical dermatology concerns, such as skin infections, suspicious moles, or potential skin cancer, OHIP (Ontario Health Insurance Plan) requires you to get a referral from your family doctor, a walk-in clinic, or a nurse practitioner. Emergency room doctors can also issue a referral for urgent cases.

• Medically necessary treatments are covered by OHIP, meaning you won’t have to pay for the consultation. However, the wait times for an OHIP-covered dermatologist can be long—sometimes up to 5 months.
• Conditions that require a referral may include eczema, psoriasis, acne, or skin cancer checks.

Non-OHIP Dermatology (Cosmetic Procedures)

For cosmetic procedures like Botox™ or mole removal, OHIP does not cover these services. You can go directly to a dermatologist, but you’ll need to cover the costs out of pocket or through private insurance.

• No referral is required for cosmetic dermatology, but the procedure will not be free unless covered by your private insurance.

Teledermatology in Ontario

To avoid long wait times, consider teledermatology. Virtual consultations can speed up the process, and OHIP covers many of these online appointments. If an in-person follow-up is needed, it can be scheduled more quickly after the initial virtual consult.

OHIP-covered dermatology wait times

Currently, OHIP-covered dermatology services in Ontario can have significant wait times, with non-urgent cases often experiencing delays of up to 4 to 5 months. This is due to the limited number of dermatologists available (approximately 275 across the province), which results in higher demand than available appointments. The wait can be particularly long for conditions that are not deemed urgent, such as mild eczema or acne, though more urgent cases, like suspected skin cancer, may receive priority and shorter waiting times.

How to see a dermatologist faster in Ontario?

Seeing a dermatologist faster in Ontario can be challenging due to long wait times for OHIP-covered services, often stretching up to 4-5 months for non-urgent cases. Here are some options to reduce waiting times:

1. Teledermatology (Virtual Appointments):
   Many clinics offer teledermatology services that are covered by OHIP. Virtual consultations allow you to see a dermatologist more quickly for an initial assessment. If further in-person care is required, you may be prioritized for follow-up visits​.
2. Walk-In Rapid Access Clinics:
   Some dermatology clinics, like Avantderm in Toronto, offer walk-in, rapid-access services. These clinics often cater to urgent skin concerns without needing a prior appointment, though the availability is limited, and there's usually a cap on how many patients they can see each day​.
3. Private Dermatology Services:
   If you're looking to avoid OHIP wait times, you can opt for private dermatology clinics. While these aren't covered by OHIP, they usually offer faster access to consultations and procedures. Costs for private consultations typically range from $100 to $250.
4. Check for Group Insurance Coverage:
   If you have private health insurance through your employer, certain dermatology services, including consultations for non-medically necessary conditions, may be covered. This could provide quicker access compared to relying on OHIP alone

How to get a referral for an OHIP-covered dermatologist in Ontario?

If you're seeking a dermatology consultation that's covered by OHIP, you'll need a referral from a doctor or nurse practitioner. Here's how the process works:

1. Visit your family doctor or a walk-in clinic.
2. Discuss your skin concern and your doctor will determine whether it’s a medical issue that needs a dermatologist’s evaluation.
3. Receive a referral from your doctor. This referral will allow you to access a dermatologist without any cost through OHIP.

Remember, each dermatological condition requires a separate referral.

How much does a dermatologist cost in Ontario?

The cost of seeing a dermatologist in Ontario varies depending on whether the consultation is covered by OHIP or if the procedure is cosmetic:

• OHIP-covered visits: Free with a valid Ontario health card and a doctor’s referral.
• Private consultations: If not covered by OHIP, expect to pay around $100 for a consultation. Non-essential procedures, like mole removal, usually start at $400.

Does OHIP cover skin removal surgery in Ontario?

Skin removal surgery may or may not be covered by OHIP, depending on the type and reason for the procedure:

• Panniculectomy: Covered by OHIP if medically necessary (e.g., after significant weight loss or if the excess skin causes rashes or ulcers).
• Abdominoplasty (tummy tuck): Not covered by OHIP as it's considered a cosmetic procedure that includes muscle tightening and liposuction.

To determine if your skin removal surgery is covered, you’ll need to consult with your doctor and meet specific criteria.

Is Accutane covered by OHIP?

Accutane, a medication for severe acne, is not covered by OHIP unless administered in a hospital or clinical setting. However, you may be eligible for coverage through the Ontario Drug Benefit (ODB) program if you qualify under certain categories:

• OHIP+: Individuals under 25 who aren’t covered by private insurance.
• Senior citizens (65 or older).
• Long-term care residents or those receiving professional home care.
• Trillium Drug Program enrollees.

Check with your healthcare provider to see if you qualify for ODB coverage.

Is mole removal covered by OHIP?

Mole removal is only covered by OHIP if the mole is deemed medically necessary, such as when a mole is suspicious of skin cancer or causing functional issues. In such cases, OHIP covers both the examination and the removal procedure.

If you're unsure whether your mole qualifies for OHIP coverage, it's advisable to consult your family doctor or a dermatologist, as they can assess whether the mole poses a medical concern.

If your dermatology needs aren't covered by OHIP, it may be worth exploring private health insurance options. Use our free comparison tool below to find the best plans in Canada and get personalized quotes in seconds.

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FAQs on OHIP Dermatology Coverage