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FSA Healthcare Savings Calculator

Total Annual Income	$

Out-of-Pocket Healthcare Expenses*
Deductibles	$
Copays/Co-insurance	$
Prescription drugs	$
Dental expenses	$
Vision expenses (eye exams, glasses, contact lens, etc.)	$
Orthodontia expenses	$
Over-the-counter drugs/medications/products	$
Other (chiropractic, hearing,allergy, etc.)	$

*Healthcare expenses should only include items considered eligible for reimbursement. Please consult your Summary Plan Description or contact your employer for plan limits.

Tax Rates
Federal	%
State	%
Social Security	7.65%

	Without FSA Healthcare	With FSA Healthcare
Taxable Income	$	$

*Taxes Withheld	$	$

Resulting Take Home Pay	$	$

After Tax Healthcare Expenses	$	$ 0.00

Disposable Income	$	$

Savings		$

The FSA Healthcare Savings Calculator for Individuals is meant to provide an estimate of tax savings based upon the information provided. Since every individuals expenses and tax situation is unique, we recommend consulting your tax advisor for additional information tailored to your specific tax situation.