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Calculate your savings and increased take-home pay by having a Flexible Spending Account
A. Healthcare Expenses
Medical
1. Deductibles / Co-Pays / Co-Insurance
$
2. Prescription Drugs
$
3. Mental Health Services
$
Dental
1. Deductibles / Co-Insurance
$
2. Orthodontia
$
Vision
1. Exams / Eye Glasses
$
2. Contacts / Contact Cleaning Solutions
$
Other Health Expenses
1. Chiropractic
$
2. Hearing Aids
$
3. Other - refer to health care list for eligible expenses
$
B. DEPENDENT CARE EXPENSES
Up to $5,000 per household, per calendar year, for the care of disabled adults of any age and children to age 13; married filing separately limit is $2,500
$
B. Income
Annual Income
(Include Spouse if Joint Filer)
Less Than $21,525
$21,526-$25,750
$25,751-$34,550
$34,551-$43,050
$43,051-$52,025
$52,026-$62,450
$62,451-$72,600
$72,601-$79,275
$79,276-$89,150
$89,151-$104,050
$104,051-$130,250
$130,251-$141,575
$141,576-$144,400
$144,401-$158,550
$158,551-$283,150
Greater Than $283,150
C. Taxes
Tax Filing Status
Single
Married Filing Joint
Married Filing Single
Head of Household
Total Expenses
$
TAX-FREE INCOME
Monthly Savings
$
Annual Savings
$
Note:
Your tax savings is based on marginal federal rates and FICA. For extra tax savings, multiply State income tax rates of 3% to 9% by the Total Expenses noted above.
