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I have had this problem too. Taxes due for inherited savings bonds (which had been converted to new bonds that deferred income taxes to heirs) that hit in a stock market crash year forcing me to take profits and pay capital gains. Not planned. But stuck with paying extra for Medicare.

Medicare Pt B is optional. So she could consider deferring coverage for the high income year. If she is in good health, she can easily compare the costs of her uninsured medical needs vs the extra premiums required to decide.

Otherwise, she does have to pay.

Medicare is a bit slow in adjusting payments when your income returns to normal, but when they send you your rate for the coming year, usually in December, if your income is now smaller on your last income tax filing, you can take it to the closest Social Security office and they will make the adjustment. (Don't wait on the phone for an appointment. Drive to the closest office, take a number and wait.)
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