FSA Estimated Expense Calculator

Estimated Annual Income:
$
Dental:
  Exams, Cleaning
$
  X-rays, fillings
$
  Crowns, root canals, dentures
$
  Orthodontia
$
Subtotal:
Vision care expenses, such as:
  Exams
$
  Eyeglasses
$
  Contact lenses
$
Subtotal:
Medical Expenses:
  Prescription Drugs
$
  Over-the-counter drugs (see list)
$
  Medical Deductibles and CoInsurance
$
  HMO copayments
$
  Routine physical exams
$
  Other eligible expenses (examples)
$
Subtotal:
Total Estimated Health Care Expenses:
Dependent Care FSA ($5000.00 max)
  Day Care Center
$
  Baby Sitter
$
  Nursery School
$
  Summer Day Camp
$
  Payment to a dependent care facility or individual
$
  Payment to other adult care providers
$
  Other
$
Subtotal:
Total Estimated Dependent Care Expenses:
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Estimated Savings: With FSA Without FSA
  Annual Income $ $
  Health Expenses
$
$
  Dependent Care Expense $ $
  Taxable Income $ $
  Tax Savings $ $
This calculator estimates 15% Federal Tax Rate, 7.65% FICA, and 4% State Tax Rate.
Your actual savings may vary depending on your own circumstances.

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