FSA Calculator

SALARY INFORMATION
Enter your annual income:
$



HEALTH CARE REIMBURSEMENT ACCOUNT

Enter the amount you expect to pay during the plan year for eligible medical expenses:

 

Medical deductibles
Medical plan co-payments and co-insurance
$
Dental plan deductibles and co-payments
$
Vision Expenses Including Glasses, Contact Lens, Exams and Supplies
$
Prescription Drugs
$
Orthodontia
$
Other Eligible Expenses
$
Eligible Over the Counter Expenses
$
 

 
Total estimated health care contributions::  
$



DEPENDENT CARE REIMBURSEMENT ACCOUNT

Enter the amount you expect to spend on eligible dependent care expenses:

 

Babysitter
$
Day Care Center
$
Nursery/Pre School
$
After-School Care
$
Summer Day Camp
$
Other Eligible Expenses
$
 
Total estimated dependent care contributions:
$



ESTIMATED TAX SAVINGS

Note: Based on 15% Federal income tax, 5% State income tax and 7.65% Social Security tax.

 

Without Spending
Account
  With Spending
Account
     
Annual Income $   $
Total health care contribution $   $
Total Dependent Care Contribution $   $
Taxable income $   $
Net income $   $



ESTIMATED SAVINGS:   $