Health Care Spending Account Calculator

Please enter amounts in whole dollars (no decimal point, comma or dollar sign).

Type of Expense NOT Covered by Insurance
(including deductibles, coinsurance and co-payments)

Projected Amount of Expense

Medical:

Dental:

Orthodontia:

Vision care:

Prescriptions:

Other expenses not covered by insurance including eligible over-the-counter medications:

   

Tax filing status (required field):
Single
Married filing jointly
Married filing separately
Head of household

Number of dependents:
Do not include yourself or your spouse.

Total annual income:
Enter income amount from all sources including wages, salary, income from a business/profession, rents/royalties, lottery winnings, investment income, etc. Please include all income sources for your spouse if your filing status above is "Married filing jointly."

to determine the following:

Total projected expenses:

Suggested contribution amount based on total projected expenses:
Maximum is $2500.

Total available for reimbursement:
Equals your contribution amount.

Total potential tax savings:
This amount represents potential federal and FICA tax savings only. You may also realize additional state tax savings.

Note: The information provided by these calculators is intended only for general information and educational purposes. The calculated results are intended for illustrative purposes only; accuracy is not guaranteed. Please consult a financial professional for advice regarding your personal circumstances. This worksheet is an estimating tool only and does not constitute an enrollment.

form and enter new projection amounts.