The legislative vote is being held a year ahead of schedule after the ruling VMRO-DPMNE failed to agree with its ethnic Albanian coalition partner, the DUI, on a joint presidential candidate.
The run-off for a largely ceremonial post will be held between incumbent Gjorge Ivanov of the VMRO-DPMNE and his Social Democrat rival Stevo Pendarovski.
More than 1.7 million voters will elect a new 123-seat parliament choosing between 14 parties and coalitions.
The ruling party is credited with 28 per cent of the vote against 15 per cent for the opposition Social Democrats (SDSM).
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VMRO-DPMNE hopes to increase its tally in parliament to 62 seats out of 123 and enable its leader Nikola Gruevski to secure a third term as prime minister.
During the campaign, Gruevski urged voters to back his government's measures to revive Macedonia's ailing economy, which showed signs of recovery last year when it posted 3.1 per cent output growth.
But with unemployment above 28 per cent in the country of two million where the average monthly salary stands at just 350 euros ($480), ordinary Macedonians remain gloomy about their prospects.
"Give us a mandate to work together and bring Macedonia into the EU and NATO," Gruevski said ahead of the vote.
The opposition says the issue is hampering economic and political development in Macedonia, an EU candidate since 2005.
Greece has a northern province also called Macedonia, and the two countries have been at loggerheads over the right to use of the name ever since the former Yugoslav republic proclaimed independence in 1991.
Among parties representing ethnic Albanians, who make up about a quarter of Macedonia's population, the Democratic Union for Integration enjoys support of about seven per cent.