I do, and I agree about their utility. My users and aliases are in OpenLDAP but it’s pretty easy to add new ones.
Separate accounts are preferable if you’re actually going to be responding to messages. I’ve had some embarrassing encounters where I’ve given an alias to a business that I didn’t realize was going to actually use it for real email conversations with a human. By default roundcube web mail lets you hit reply anyway and the reply goes out with your real address, which can lead to confusion.
Not really, it’s been pretty effortless. Every couple months I have to make sure my renewed LetsEncrypt certs really got imported, but I don’t think I’ve had to intervene manually for anything in a long time.