Does OHIP Cover Dermatology? (2024)

The skin is the largest organ in the body. It protects the body from external threats like bacteria and viruses, but our skin only does its job if we keep it healthy and monitored. In Canada, millions of people live with skin conditions such as psoriasis and rosacea.

Our skin is often neglected, and many tend to underestimate the importance of seeing a dermatologist. For example, did you know the cure rate for skin cancer is 90% if the patient self-examines their skin and catches it early? That rate significantly drops, however, if the cancer isn’t caught early. How long has it been since you’ve seen a dermatologist?

This guide will take you through everything you need to know about dermatologists and OHIP. Learn about eligibility, what is covered and how to get coverage.

Are dermatologists covered by OHIP?

The short answer is yes, a consultation with a dermatologist is covered by OHIP. Anyone requiring an expert assessment or care for skin, hair or nails can see a dermatologist at no cost. However, there are a few conditions to OHIP coverage.

The first thing you need is a referral from a physician for a general dermatology appointment. The first visit and any follow-up visits fall under OHIP dermatology coverage, meaning they are free.

If you have been referred by a doctor or nurse practitioner, then most dermatology treatments will be covered by OHIP, as long as they are considered medically necessary. In other words, dermatology covered by OHIP does not include clinic appointments, assessments or procedures that are cosmetic or medically unnecessary. In any case, a good OHIP-covered dermatologist should speak with you about which treatments are elective and how much they would cost you.

Below are some common dermatology procedures and their coverage under OHIP.

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. In addition, most medications are insured under private health insurance policies.

Depending on your condition, your health might be better off with private health insurance. It’s worth checking if you are already covered by group insurance, for example, through your employer.

How to see a dermatologist in Ontario?

If you need to see a dermatologist in Ontario, you probably fit into one of two broad categories: your treatment is medically required, so your dermatology needs are covered by OHIP; or your needs are cosmetic or not medically urgent, in which case they will not be OHIP-covered.

Unless you know for a fact that what you need is cosmetic, for example, Botox™ injections for wrinkles, then your first step is to see your family doctor or one at a walk-in clinic. For medical dermatology concerns, OHIP requires patients to be referred by a doctor or nurse practitioner. If your case is urgent, even your local emergency room can issue a referral. Each skin condition or concern requires a separate referral.

Besides your referral, you’ll also need a valid Ontario health card. Remember to take this card with you to any appointments as it’s unlikely you’ll be treated without it, even if your consultation is virtual.

With your OHIP card and a referral in your possession, you can book a dermatology appointment, and it will be covered by OHIP.

Note that OHIP-covered dermatology consultations can have long waiting times, sometimes up to 5 months. In Ontario, there’s about 1 dermatologist for every 50,000 people, which means the wait can get long depending on supply and demand. To try to avoid extended waiting times, you might want to consider teleconsultations. Most conditions can be treated virtually with the same care and quality as in-person treatments. This type of service is usually streamlined so that there are fewer delays and less bureaucracy which lowers the waiting times. If the dermatologist feels you need an in-person consultation after the virtual appointment, your case is usually taken care of more quickly.

It’s also worth checking if your dermatology needs are covered by group insurance such as through your employer. If you are covered, it’s likely to go quicker.

To get the best coverage, it’s always worth considering private health insurance. Comparing different companies and option is sure to get you the best deal.

Do I need a referral to see a dermatologist in Ontario?

If you want your dermatology appointment to be covered by OHIP or any other insurance provider, you’ll have to get a referral from a doctor or nurse practitioner. In Ontario, a dermatology visit that is referred is always free.

For cosmetic dermatological needs (for example removing a non-suspicious mole), you do not need a referral, but you will have to pay for the procedure yourself or via private insurance.

As you can see from the example, OHIP coverage is not always simple, but it is usually a good idea to start by seeing your doctor for any dermatology concerns.

How much does a dermatologist cost in Ontario?

In Ontario, medically necessary dermatology appointments are covered by OHIP, which means they are free for Ontarians.

OHIP pays the dermatologist or dermatology clinic $72.15 per first consultation, $44.45 per teleconsultation and $38.70 for a subsequent visit required after teledermatology. Repeat assessments regarding the same problem are paid at a lower rate.

If you are not covered by OHIP or if your dermatology needs are cosmetic, the price will vary from clinic to clinic. But in general, you can expect to pay around $100 for a consultation. In Ontario, any non-essential dermatology procedures generally cost upwards of $400.

Is skin tag removal covered by OHIP?

No. As a non-medically necessary service, skin tag removal is not covered by OHIP. If you want a skin tag removed, you can book an appointment with a dermatologist directly, without a referral from a doctor or nurse practitioner.

Does OHIP cover skin removal surgery?

Skin removal surgery in Canada may be covered by OHIP under certain circumstances.

Surgery to assist with weight loss (or bariatric surgery) is often considered medically necessary and covered by OHIP. However, with drastic weight loss often comes excess skin in the abdominal area. To remove this unwanted skin, you have two options: abdominoplasty or panniculectomy.

Abdominoplasty is not covered by OHIP. As a service that combines skin removal with liposuction, sculpting, abdominal muscle tightening and belly button reconstruction, this procedure is not considered medically necessary.

A panniculectomy can be covered by OHIP, depending on certain factors. This procedure is the surgical removal of excess abdominal skin, without any muscle tightening, waist slimming or supplementary liposuction. Qualifications for skin removal surgery covered by OHIP may include a weight loss superior to 100 lbs and having excess skin hanging to the level of the pubis. Moreover, dermatological issues such as rashes and ulcers can become a concern. The significant health benefits that come with this surgery often mean it is considered medically necessary.

Is Accutane covered by OHIP?

OHIP does not cover Accutane (a medication primarily used to treat severe acne) or any other medication administered outside of a hospital or clinical setting. However, you might be eligible for coverage under the Ontario Drug Benefit (ODB). This program covers most of the cost of approximately 5,000 medications, including Accutane in specific clinical situations.

If you have an Ontario health card, you may be covered by ODB if you are also:

• Eligible for OHIP+ (anyone younger than 25 years old who is not covered by a private plan is. You do not have to enroll or register to access OHIP+ coverage)
• Age 65 or older
• Living in a long-term care home or a home for special care
• Receiving professional home and community care services
• Enrolled in the Trillium Drug Program

You are also covered by ODB if you are enrolled in Ontario Works (OW) or the Ontario Disability Support Program (ODSP).

Not eligible for coverage? A private health insurance plan might be right for you.

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Alexandre Desoutter

Alexandre Desoutter has been working as editor-in-chief and head of press relations at HelloSafe since June 2020. A graduate of Sciences Po Grenoble, he worked as a journalist for several years in French media, and continues to collaborate as a as a contributor to several publications.