Calculate Your FSA Tax Savings

By completing the following information, you can calculate your annual reimbursable expenses.

Select Your Pay Cycle  

Healthcare Expenses for you and your dependents (annual estimates)

Chiropractic $
Deductibles $
Dental checkups $
Doctor visits and co-pays $
Eye exams & surgery $
Fillings/crowns $
Glasses/contacts/solutions $
Orthodontia $
Prescribed medical supplies/equipment $
Prescription drugs $
Psychiatric or Psychologist's fees $
Travel to doctor or hospital $
Weight-loss programs
(associated with a specific disease).
Other $
Total $

Dependent Day Care Expenses (annual estimates)

Before and after school care $
Care of child over age 13 $
Elder daycare $
Summer day camps $
Other $
Total $

Total Expenses

Total Healthcare Expenses
(IRS 2021 Health FSA max contribution is $2,750)
Total Dependent Care Expenses
(IRS Dependent Care FSA max contribution is $5,000 per family)
Total Annual Expenses $
Annual Tax Savings (approximately 25%) $
Estimated Savings Amount Per Paycheck $

Please note: Tax savings amounts are estimated. Please contact your tax advisor for savings amounts specific to your household earnings.