I have a 2019 3500 HO
Mine is babied, as I don't need to use it in the winter, so I have about 37 K on it. Nothing untoward has happened to it, save the infernal recalls.
If my memory serves me correctly, there was an issue with the 2020 and /or 2021 3500 HO models. Being quasi-old and decrepit it was either the engine or the Aisain.
Again, while I put it away for the winter, it hauls everything and anything the rest of the year.
Did I waste my money? Possibly, but my son had a 2020 Laramie 2500 CTD and had problems, not with the mechanical, save any recalls, but the electronics. He bought coverage for that, among other things, and has recently traded it and bought himself a 2005 Laramie 3500 dualie with a high output and pleased as punch. It was the recalls and the electronic "stuff" that did him in. He is barely into his 30's, so he is not a techno-boob, like my husband.
Do I regret spending the $$. Nope. I only bought the extended coverage due to my situation. I have bought CTDs for years without the additional expense. It's as someone else previously said - a 50-50 crap shoot and just consider it like life insurance - should have it but...
You have to know what you will put up with because no one can tell you what may or may not happen and that goes for anything that you buy now.