| Prevseason: | 2017–18 |
| Nextseason: | 2019–20 |
| Season: | 2018–19 |
| Macedonian First League | |
| T Bg: | white |
| T Color: | black |
| Teams: | 11 |
| Mvp N: | MKD |
| Tv: | Macedonian Radio Television |
| Promoted: | MZT Skopje Aerodrom 2 Akademija FMP |
| Relegated: | Shkupi |
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.[1]
The two last qualified teams will join the relegation playoffs with the two best teams from the Second League.
Eleven teams joined the league as Vodnjanska was not admitted in the league.
Vardar replaced Karpoš Sokoli and Strumica, relegated from the previous season.
| Team | Home City | Arena | Coach | |
|---|---|---|---|---|
| AV Ohrid | Ohrid | Biljanini Izvori |  Petar Čočoroski | |
| Blokotehna | Gevgelija | Sportska Sala Blokotehna | Marjan Ilievski | |
| Feni Industries | Kavadarci | Jasmin | Ljupčo Malinkov | |
| Gostivar | Gostivar | Mladost Gostivar | Marjan Srbinovski | |
| Kožuv | Gevgelija | 26-ti April | Pavle Nikolov | |
| Kumanovo 2009 | Kumanovo | Sports Hall Kumanovo | Aleksandar Petrović | |
| MZT Skopje Aerodrom | Skopje | Jane Sandanski Arena | ||
| Pelister | Bitola | Sports Hall Mladost | Petar Sozovski | |
| Rabotnički | Skopje | Gradski Park | Marin Dokuzovski | |
| Shkupi | Skopje | Šaban Trstena | Enver Miftari | |
| Vardar | Skopje | Kale | Darko Radulović |
| Teams that play in the 2018–19 Second Adriatic League | ||
| Teams that play in the 2018–19 BIBL |
Playoffs will be played with a best-of-five games format, where the seeded team played games 1, 2 and 5 at home.
|}