N-type Mg3Sb2-xBix alloys have been extensively studied in recent years due to their significantly enhanced thermoelectric figure of merit (zT), thus promoting them as potential candidates for waste heat recovery and cooling applications. In this review, the effects resulting from alloying Mg3Bi2 with Mg3Sb2, including narrowed bandgap, decreased effective mass, and increased carrier mobility, are summarized. Subsequently, defect-controlled electrical properties in n-type Mg3Sb2-xBix are revealed. On one hand, manipulation of intrinsic and extrinsic defects can achieve optimal carrier concentration. On the other hand, Mg vacancies dominate carrier-scattering mechanisms (ionized impurity scattering and grain boundary scattering). Both aspects are discussed for Mg3Sb2-xBix thermoelectric materials. Finally, we review the present status of, and future outlook for, these materials in power generation and cooling applications.