MX vs. ATV Alive is the fourth installment in the MX vs. ATV series and the sequel to MX vs ATV Reflex. Just like its predecessors, the game features several different racing modes. Players can use dirt bikes and ATVs for racing. Unlike MX vs. ATV Unleashed, no monster trucks, buggies or airplanes can be used.

The game features a multiplayer and single-player mode. Multiplayer can be played offline with two people split-screen, and online against multiple opponents through the internet. Multiplayer races are broken down in skill of the player (rookie, amateur and pro) and MX (dirt bike) or ATV. Amateur races are unlocked by obtaining a player level of 10, and pro races a level of 25.

Single-player races feature several different racing courses, riding on snow, sand or dirt. New courses can be unlocked by becoming a higher level driver, with the highest courses requiring a player level of 25. Before starting a race, the player can customize the skill of the opponent, how many laps have to be driven and which vehicle the opponent uses. Finishing races, finishing first place, making it to the podium and completing race goals all give the player experience which is used to level up. By using the same vehicle for several races, vehicle experience is earned to level up that specific vehicle.