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HEALTH CARE FLEXIBLE SPENDING ACCOUNT (HCFSA) PROGRAM SAVINGS CALCULATOR FOR PLAN YEAR 2024

- Enter the requested information below to calculate your HCFSA tax savings
- Use the TAB key or mouse to move within the worksheet
- Do not use the ENTER key as a way to navigate through this worksheet or to complete your calculation.

Number of Exemptions Claimed:        Federal          State           City
Tax Status:        Single    Married
Your Gross Annual Income:       $  
Are you in the Pension System?        Yes    No

Annual Pension Contribution:       $  
Enter Annual Health Insurance Premium:       $
Enter annual contribution to the Health Care Flexible Spending Account Program (maximum $3,200, including annual administrative fee of up to $48):       $  
If you participate in the Dependent Care Assistance Program, enter annual contribution (maximum $5,000, including annual administrative fee of up to $48):       $  
Enter annual contribution to the TDA Plans (457, 401k, 403b), including Deferral Acceleration for Retirement (DAR), if any:       
$
Excluding DAR, is your annual contribution to any one of the TDA Plans equal to or more than 7.5% of your gross annual income?      
  Yes     No
Enter annual After-Tax Deductions (MCU, Union Dues, Saving Bonds, Pension Loan, Child Support, etc.):      $

  
HCFSA SAVINGS

With HCFSA
 Without HCFSA
YOUR GROSS ANNUAL INCOME: $ $
P

R

E

T

A

X

 Pension Contribution:
Health Insurance Premium:
Annual amount for Health Care Flexible Spending Account Program Expenses:

     
Health Care Flexible Spending Account Program Administrative Fee:
Dependent Care Assistance Program annual contribution:
Deferred Compensation Plan annual contribution:
ADJUSTED GROSS INCOME: $ $
Federal Income Tax:
New York State Income Tax
New York City Income Tax
FICA Deductions
Medicare Deductions
After-Tax Cost of Health Care Expenses

   
After-Tax Deductions (MCU, Union Dues, Saving Bonds, Pension Loan, Child Support, etc.)
TAKE-HOME PAY
HCFSA TAX SAVINGS

Please Note: 1) This worksheet provides only estimates of tax information and should not be assumed to be tax advice. Be sure to consult a tax advisor to determine the appropriate tax advice for your financial situation.  2) This worksheet is not intended nor shall be construed as a guarantee of tax savings.

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