Add this to your end-of-year to-do list: Sign up for your employer’s flexible spending account to pay for next year's child-care and medical bills with pre-tax dollars. You’ll be among a savvy minority. Although flex accounts are a valuable way to stretch dollars, fewer than one-quarter of eligible employees take advantage of them, according to a recent survey by Hewitt Associates.

Salary that goes into these reimbursement plans dodges federal income and Social Security taxes and, in most states, state income tax, too. Flex-account distributions are tax-free, and the full amount you allocate for the entire year is available immediately.

For example, if you put the maximum $5,000 into a plan to pay child-care bills that you have to pay anyway, you would save nearly $2,000 in taxes (assuming a 25% federal bracket, 5% state bracket and 7.65% Social Security tax.) A dependent-care account also can be used to pay for help for an elderly parent or other family member who lives with you.

Although health-related expenses are tougher to predict, you can save big by paying for your out-of-pocket health-care costs with pre-tax dollars. That’s particularly important now as more employers are asking their employees to share the burden of rising health-insurance expenses by paying higher deductibles and co-pays. Although the law sets no ceiling on contributions to health-care flex accounts, employers often set dollar limits. Use our calculator to find out how much you should put into your flexible spending account.

And now you have an even better reason to fund a flex account. In the past, if you didn’t clean out your account by December 31, you forfeited the balance. But many employers now grant a two-and-a-half-month grace period beyond the traditional deadline. If your company is one of them and your current balance is not enough to pay for an anticipated expense, such as laser eye surgery, wait until January, when your 2009 contribution will be added to the remainder of your 2008 balance. Then you can cover the full cost with pre-tax dollars.

Finally, more employers are starting to offer another tax-advantaged option for out-of-pocket medical expenses: health savings accounts. HSAs, which must be paired with a high-deductible health insurance plan, have no use-it-or-lose-it provision. Unused funds roll over from year to year and you can take the money with you when you switch jobs or retire. Like flexible spending accounts, HSA funds are tax-deductible, grow tax-deferred and distributions are tax-free as long as you use them for medical expenses.

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