The 2018–19 Macedonian First League was the 27th season of the Macedonian First League, with 11 teams participating.

Rabotnički were the defending champions.

The eleven teams that compose the league played a double-legged round robin tournament.

Vardar replaced Karpoš Sokoli and Strumica, relegated from the previous season.

Playoffs will be played with a best-of-five games format, where the seeded team played games 1, 2 and 5 at home.