Close this window:
Calculate Your FSA Tax Savings
Regarding you and your eligible dependents:
Monthly, how many monthly prescriptions will you get filled?
What is your average presciption co-payment?
$
«
Monthly, what will you pay for eligible over-the-counter medicines?
$
Actual Cost:
$
Annually, how many times will you go to the doctor?
What is your office visit co-payment?
$
«
Actual Cost:
$
How many people in your family will pay an annual deductible under a medical or health plan?
What is your annual medical deductible per family member?
$
«
Actual Cost:
$
How many people in your family will pay an annual deductible under a dental plan?
What is your annual dental deductible?
$
«
Annually, how much will you pay out-of-pocket (after insurance) for dental fillings and crowns?
$
«
Actual Cost:
$
Annually, how many monthly payments will you make for orthodontia?
What do you pay per month for orthodontia?
$
How much will you pay in down payments for new braces?
$
How much of your orthodontia expenses will be covered by your dental plan?
$
Actual Cost:
$
Annually, how many times will you go to the chiropractor?
What do you pay per visit to the chiropractor?
$
«
Actual Cost:
$
How many times will you get acupuncture treatments?
What do you pay per visit to the acupuncturist?
$
«
Actual Cost:
$
How many times will you see a counselor or therapist?
What do you pay per visit to the counselor or therapist?
$
«
Actual Cost:
$
Annually, what will you pay out-of-pocket (after insurance, if any) for prescription eyeglasses?
$
«
Annually, what will you pay out-of-pocket (after insurance, if any) for prescription sunglasses?
$
«
Annually, what will you pay out-of-pocket (after insurance, if any) for contact lenses and cleaning solutions?
$
«
Annually, what will you pay out-of-pocket (after insurance, if any) for corrective eye surgery?
$
«
Actual Cost:
$
What will you pay out-of-pocket (after insurance, if any) for other eligible expenses
$
Suggested Plan Year Election:
$
Percentage of your gross salary that you pay in federal, state & local taxes:
%
FICA (includes Medicare):
%
Total taxes:
%
Estimated tax savings:
$