The FSA calculator helps you add up your FSA-eligible expenses and see how much you can save by using pre-tax money for out-of-pocket health care costs.

Your Health Care Expenses (Out-of-Pocket)		Estimated Yearly Cost
Medical (Office visits, X-rays, diagnostic tests, mental health care, testing devices, syringes, crutches, other durable medical equipment, etc.)		$
Prescriptions, Over-the-Counter Drugs, and Supplies (Out-of-pocket prescription drug costs, allergy medicines, smoking cessation products, at-home screening tests, diabetes supplies, contact lens solution, etc.)		$
Dental (Office visits, braces, crowns, fillings, X-rays, etc.)		$
Vision (Eye exams, glasses, contacts, laser surgery, etc.)		$
	Total Out-of-Pocket Estimated Expenses:	$0

Your Annual Income (Annual Income is used to estimate your tax liability.)		$
Your Suggested Contribution (For an FSA, we recommend that you contribute 80% of your total out-of-pocket expenses.)		$
	Adjusted Annual Income (Your Annual Income minus your contribution amount.)	$0
	Tax Savings (Tax savings based on the amount you contribute to an FSA.)	$0