It's insurance. If you aren't comfortable making repairs, buy the insurance.
The only time you'd be really screwed without it is if the motherboard or onboard video dies.
I've had a bad hard drive and power supply on a mid-2007 24-inch iMac. Replaced them on my own, though. Uses a regular hard drive and a power supply from a Mac parts supplier online.
I was able to upgrade the HD when I replace it on my own, which was nice.
The power supply blew because I was using a standard UPS, rather than one that generates a pure sine wave output (google "PFC power supply UPS") if you aren't aware of the difference.
If the motherboard had blown, I'd have bought a new iMac and moved on with work the same day using the Time Machine backup.
We've had about 7 iMacs over the years and they are largely reliable, but just like Toyotas you may find that you need to do repairs, no matter how reliable.
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