We predict the existence of α Ori B, a low-mass companion orbiting Betelgeuse. This is motivated by the presence of a 2170 day long secondary period (LSP) in Betelgeuse’s lightcurve, a periodicity that is ≈5 times longer than the star’s 416 day fundamental radial pulsation mode. While binarity is currently the leading hypothesis for LSPs in general, the LSP and the radial velocity (RV) variations observed in Betelgeuse, taken together, necessitate a revision of the prevailing physical picture. Specifically, the lightcurve–RV phase difference requires a companion to be behind Betelgeuse at the LSP luminosity minimum, ≈180° out of phase with the system orientation associated with occultation. We demonstrate the consistency of this model with available observational constraints and identify tensions in all other proposed LSP hypotheses. Within this framework, we calculate a mass for α Ori B of
M
sin
i
=
1.17
±
0.7
M
⊙
and an orbital separation of 1850 ± 70 R
⊙, or
2.43
−
0.32
+
0.21
times the radius of Betelgeuse. We then describe the features of the companion as constrained by the fundamental parameters of Betelgeuse and its orbital system, and discuss what would be required to confirm the companion’s existence observationally.