Only during hot F2 openings do you find SSB much above 50.200. If you want to win contests, yes. Most serious operators are horizontally polarized, but cross-polarization does not matter for Es, F2, or Aurora. A few stations use 3-element beams, but a 4 or 5 element beam is so small that a LOT of people use them. There are a few other big beams, and the lunatic fringe stacks them.
Some people have multiple antennas at multiple heights to work different kinds of propagation modes.
I live in subdivision where no outdoor antennas are allowed, so I use a 2-element beam in the attic, and it works pretty well. I also use a vertical for local FM work. RG8 or RG213 is plenty good enough cable for most people. Antenna-mounted preamps are never needed. External noise is fairly high at 50 MHz.