Tax Savings Calculator

Health Flexible Spending Account (FSA) Worksheet

This worksheet can help you decide an appropriate election for a Health FSA and estimate the amount of your tax savings. List medical expenses you regularly experience and any additional expected medical expenses that will be incurred during the plan year. Medical bills, bank records, and Explanation of Benefits statements (EOBs) can be helpful in projecting future expenses. For detailed tax rate information, consult your tax advisor.

ESTIMATE YOUR MONTHLY OUT-OF-POCKET HEALTH EXPENSES:

BE CONSERVATIVE!
Include in your estimate only amounts that you are confident will be incurred by you and your family during the plan year.

Medical (see eligible expenses on website)$ per month
Prescriptions$ per month
Dental/Orthodontia$ per month
Vision (glasses, contacts, etc.)$ per month

Total MONTHLY Expenses
$0.00 per month
Total ANNUAL Expenses
$0.00 (ANNUAL ESTIMATED HEALTH FSA EXPENSES)

What is your annual household income?$
How many children can you claim on your taxes?
What is your tax filing status?
State in which you live
Estimated Annual Taxable Income
$0.00

Estimated Annual Tax Savings
$0.00

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Flex-inquire@askallegiance.com